- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.84 / $895.41 / $1,604.96
| Professional | | $88.84 | $895.41 | $1,604.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.79 / $214.79 / $1,280.75
| Professional | | $214.79 | $214.79 | $1,280.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.26 / $396.32 / $1,687.29
| Professional | | $93.26 | $396.32 | $1,687.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.83 / $1,387.07 / $6,893.12
| Professional | | $916.83 | $1,387.07 | $6,893.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.71 / $1,029.19 / $1,523.56
| Professional | | $102.71 | $1,029.19 | $1,523.56 |