- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.84 / $1,361.83 / $2,112.77
| Professional | | $719.84 | $1,361.83 | $2,112.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.54 / $768.94 / $1,286.24
| Professional | | $184.54 | $768.94 | $1,286.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.74 / $1,253.25 / $2,652.64
| Professional | | $713.74 | $1,253.25 | $2,652.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.93 / $1,901.64 / $2,638.77
| Professional | | $967.93 | $1,901.64 | $2,638.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.53 / $1,090.94 / $1,802.70
| Professional | | $171.53 | $1,090.94 | $1,802.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.46 / $2,091.66 / $2,942.61
| Professional | | $1,582.46 | $2,091.66 | $2,942.61 |