- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.50 / $1,120.60 / $1,608.92
| Professional | | $196.50 | $1,120.60 | $1,608.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.94 / $1,010.85 / $1,439.60
| Professional | | $145.94 | $1,010.85 | $1,439.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.52 / $232.35 / $331.34
| Professional | | $190.52 | $232.35 | $331.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.62 / $1,113.01 / $2,674.13
| Professional | | $210.62 | $1,113.01 | $2,674.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.46 / $2,102.21 / $2,706.30
| Professional | | $1,385.46 | $2,102.21 | $2,706.30 |