- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.65 / $166.65 / $1,174.38
| Professional | | $166.65 | $166.65 | $1,174.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.81 / $183.75 / $890.05
| Professional | | $137.81 | $183.75 | $890.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.21 / $264.56 / $362.60
| Professional | | $139.21 | $264.56 | $362.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $209.37 / $1,419.41
| Professional | | $154.30 | $209.37 | $1,419.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $194.06 / $379.80
| Professional | | $154.30 | $194.06 | $379.80 |