- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $245.47
| Professional | | $114.82 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $467.74
| Professional | | $151.36 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $363.08
| Professional | | $141.25 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $295.12
| Professional | | $162.18 | $223.87 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $169.82 / $281.84
| Professional | | $123.03 | $169.82 | $281.84 |