- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $363.08 / $741.31
| Professional | | $194.98 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $562.34 / $1,000.00
| Professional | | $316.23 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $933.25
| Professional | | $354.81 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $891.25
| Professional | | $354.81 | $645.65 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $549.54 / $1,000.00
| Professional | | $79.43 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $977.24
| Professional | | $416.87 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,023.29
| Professional | | $331.13 | $575.44 | $1,023.29 |