- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $141.13 / $175.82
| Professional | | $116.76 | $141.13 | $175.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.04 / $156.63 / $250.86
| Professional | | $126.04 | $156.63 | $250.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $199.86 / $308.72
| Professional | | $128.00 | $199.86 | $308.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.88 / $259.27 / $1,418.00
| Professional | | $146.88 | $259.27 | $1,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.19 / $190.05 / $437.15
| Professional | | $144.19 | $190.05 | $437.15 |