- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $776.25
| Professional | | $234.42 | $323.59 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,000.00
| Professional | | $371.54 | $371.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $537.03
| Professional | | $245.47 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $467.74
| Professional | | $275.42 | $371.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $363.08 / $645.65
| Professional | | $302.00 | $363.08 | $645.65 |