- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.13 / $318.27 / $442.67
| Professional | | $176.13 | $318.27 | $442.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.86 / $379.92 / $651.77
| Professional | | $215.86 | $379.92 | $651.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.84 / $374.73 / $730.77
| Professional | | $207.84 | $374.73 | $730.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,904.00 / $3,990.72 / $3,990.72
| Professional | | $3,904.00 | $3,990.72 | $3,990.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.09 / $481.04 / $908.73
| Professional | | $376.09 | $481.04 | $908.73 |