- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.41 / $206.17 / $1,011.44
| Professional | | $183.41 | $206.17 | $1,011.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.46 / $153.94 / $192.43
| Professional | | $115.46 | $153.94 | $192.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.39 / $234.50 / $407.70
| Professional | | $180.39 | $234.50 | $407.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.52 / $219.96 / $1,418.24
| Professional | | $173.52 | $219.96 | $1,418.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $207.26 / $377.29
| Professional | | $170.00 | $207.26 | $377.29 |