- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.08 / $161.83 / $213.93
| Professional | | $130.08 | $161.83 | $213.93 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $153.29 / $153.29 / $195.00
| Professional | 25 | $153.29 | $153.29 | $195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $148.91 / $185.88
| Professional | | $148.91 | $148.91 | $185.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $132.76 / $152.76 / $168.93
| Professional | 25 | $132.76 | $152.76 | $168.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $163.81 / $208.43
| Professional | | $119.58 | $163.81 | $208.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.60 / $147.60 / $166.00
| Professional | | $147.60 | $147.60 | $166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.01 / $150.40 / $222.78
| Professional | | $121.01 | $150.40 | $222.78 |