- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.68 / $1,248.31 / $1,603.47
| Professional | | $176.68 | $1,248.31 | $1,603.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.04 / $58.94 / $357.64
| Professional | | $45.04 | $58.94 | $357.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.87 / $830.36 / $2,155.69
| Professional | | $188.87 | $830.36 | $2,155.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.08 / $1,431.55 / $1,789.63
| Professional | | $240.08 | $1,431.55 | $1,789.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.35 / $1,193.14 / $1,737.78
| Professional | | $963.35 | $1,193.14 | $1,737.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.96 / $1,886.34 / $2,491.55
| Professional | | $1,482.96 | $1,886.34 | $2,491.55 |