- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.42 / $164.75 / $1,002.05
| Professional | | $100.42 | $164.75 | $1,002.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.72 / $253.10 / $652.28
| Professional | | $214.72 | $253.10 | $652.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.43 / $200.15 / $318.00
| Professional | | $164.43 | $200.15 | $318.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.06 / $212.79 / $318.00
| Professional | | $148.06 | $212.79 | $318.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.66 / $206.59 / $462.57
| Professional | | $106.66 | $206.59 | $462.57 |