- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.97 / $189.05 / $1,055.01
| Professional | | $173.97 | $189.05 | $1,055.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.61 / $177.03 / $352.96
| Professional | | $172.61 | $177.03 | $352.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.07 / $152.07 / $152.07
| Professional | | $152.07 | $152.07 | $152.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.85 / $245.86 / $1,164.67
| Professional | | $191.85 | $245.86 | $1,164.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.85 / $245.86 / $325.54
| Professional | | $191.85 | $245.86 | $325.54 |