- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.17 / $256.55 / $420.49
| Professional | | $239.17 | $256.55 | $420.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.03 / $318.02 / $5,359.00
| Professional | | $228.03 | $318.02 | $5,359.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.26 / $357.79 / $859.31
| Professional | | $233.26 | $357.79 | $859.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.35 / $463.52 / $745.00
| Professional | | $345.35 | $463.52 | $745.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.66 / $300.56 / $886.34
| Professional | | $261.66 | $300.56 | $886.34 |