- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.96 / $494.37 / $2,158.33
| Professional | | $378.96 | $494.37 | $2,158.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.79 / $708.34 / $994.15
| Professional | | $403.79 | $708.34 | $994.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.77 / $1,186.58 / $1,573.93
| Professional | | $469.77 | $1,186.58 | $1,573.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.08 / $1,122.48 / $5,098.60
| Professional | | $637.08 | $1,122.48 | $5,098.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.47 / $1,070.38 / $1,429.18
| Professional | | $800.47 | $1,070.38 | $1,429.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.08 / $1,122.48 / $1,250.76
| Professional | | $637.08 | $1,122.48 | $1,250.76 |