- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.63 / $246.46 / $903.87
| Professional | | $195.63 | $246.46 | $903.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.96 / $206.20 / $206.20
| Professional | | $164.96 | $206.20 | $206.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.22 / $339.00 / $602.83
| Professional | | $137.22 | $339.00 | $602.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $265.45 / $1,308.32
| Professional | | $170.00 | $265.45 | $1,308.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.54 / $245.69 / $328.30
| Professional | | $168.54 | $245.69 | $328.30 |