- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $239.88 / $302.00
| Professional | | $114.82 | $239.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $239.88 / $436.52
| Professional | | $177.83 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $316.23 / $524.81
| Professional | | $165.96 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $1,479.11
| Professional | | $251.19 | $446.68 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $457.09
| Professional | | $134.90 | $245.47 | $457.09 |