- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.16 / $207.12 / $263.37
| Professional | | $160.16 | $207.12 | $263.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.79 / $170.00 / $1,030.00
| Professional | | $134.79 | $170.00 | $1,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.07 / $229.87 / $581.24
| Professional | | $159.07 | $229.87 | $581.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.47 / $239.44 / $506.51
| Professional | | $227.47 | $239.44 | $506.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.34 / $234.62 / $615.72
| Professional | | $174.34 | $234.62 | $615.72 |