- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.47 / $243.88 / $725.00
| Professional | | $136.47 | $243.88 | $725.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.28 / $167.18 / $213.99
| Professional | | $125.28 | $167.18 | $213.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.47 / $260.88 / $533.41
| Professional | | $169.47 | $260.88 | $533.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.90 / $355.85 / $591.14
| Professional | | $231.90 | $355.85 | $591.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.19 / $255.53 / $618.23
| Professional | | $140.19 | $255.53 | $618.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.76 / $317.23 / $387.02
| Professional | | $148.76 | $317.23 | $387.02 |