- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.41 / $497.64 / $2,271.92
| Professional | | $334.41 | $497.64 | $2,271.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.29 / $725.67 / $2,306.39
| Professional | | $410.29 | $725.67 | $2,306.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.39 / $1,116.08 / $3,403.55
| Professional | | $408.39 | $1,116.08 | $3,403.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.04 / $733.07 / $2,252.59
| Professional | | $371.04 | $733.07 | $2,252.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.41 / $497.64 / $2,271.92
| Professional | | $334.41 | $497.64 | $2,271.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.63 / $1,641.69 / $2,521.28
| Professional | | $1,180.63 | $1,641.69 | $2,521.28 |