- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.79 / $411.27 / $1,689.22
| Professional | | $311.79 | $411.27 | $1,689.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.50 / $664.12 / $1,976.12
| Professional | | $345.50 | $664.12 | $1,976.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.01 / $1,013.01 / $2,700.57
| Professional | | $364.01 | $1,013.01 | $2,700.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.57 / $670.89 / $2,116.57
| Professional | | $339.57 | $670.89 | $2,116.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.79 / $411.27 / $1,689.22
| Professional | | $311.79 | $411.27 | $1,689.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.97 / $1,574.22 / $2,035.63
| Professional | | $1,167.97 | $1,574.22 | $2,035.63 |