- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.52 / $170.81 / $227.31
| Professional | | $143.52 | $170.81 | $227.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.21 / $215.54 / $301.91
| Professional | | $152.21 | $215.54 | $301.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.12 / $215.71 / $361.99
| Professional | | $148.12 | $215.71 | $361.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.51 / $221.02 / $2,295.00
| Professional | | $152.51 | $221.02 | $2,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.36 / $182.27 / $294.10
| Professional | | $145.36 | $182.27 | $294.10 |