- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.62 / $273.06 / $1,101.50
| Professional | | $255.62 | $273.06 | $1,101.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.72 / $345.74 / $540.00
| Professional | | $323.72 | $345.74 | $540.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.63 / $378.73 / $720.03
| Professional | | $267.63 | $378.73 | $720.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.75 / $389.36 / $621.09
| Professional | | $292.75 | $389.36 | $621.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.10 / $352.46 / $709.50
| Professional | | $250.10 | $352.46 | $709.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.38 / $336.66 / $407.04
| Professional | | $275.38 | $336.66 | $407.04 |