- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $457.09 / $1,122.02
| Professional | | $380.19 | $457.09 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $2,454.71
| Professional | | $338.84 | $489.78 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $1,122.02
| Professional | | $398.11 | $524.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,000.00 / $1,258.93
| Professional | | $549.54 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,148.15
| Professional | | $371.54 | $524.81 | $1,148.15 |