- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,122.02 / $1,621.81
| Professional | | $169.82 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $3,388.44
| Professional | | $389.05 | $478.63 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,691.53 / $8,709.64
| Professional | | $1,230.27 | $2,691.53 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $398.11 / $3,311.31
| Professional | | $389.05 | $398.11 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,621.81 / $2,238.72
| Professional | | $295.12 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $478.63 / $3,890.45
| Professional | | $199.53 | $478.63 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $2,754.23
| Professional | | $354.81 | $436.52 | $2,754.23 |