- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.32 / $212.17 / $300.38
| Professional | | $111.32 | $212.17 | $300.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.75 / $235.62 / $390.00
| Professional | | $138.75 | $235.62 | $390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $62.64 / $334.95
| Professional | | $32.34 | $62.64 | $334.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.09 / $255.50 / $463.40
| Professional | | $149.09 | $255.50 | $463.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.04 / $316.20 / $478.84
| Professional | | $231.04 | $316.20 | $478.84 |