- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.68 / $823.18 / $1,355.34
| Professional | | $81.68 | $823.18 | $1,355.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.47 / $659.97 / $1,314.14
| Professional | | $103.47 | $659.97 | $1,314.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.14 / $399.14 / $1,608.22
| Professional | | $101.14 | $399.14 | $1,608.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $252.25 / $1,297.66
| Professional | | $32.34 | $252.25 | $1,297.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.54 / $928.32 / $2,036.03
| Professional | | $105.54 | $928.32 | $2,036.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.31 / $1,226.25 / $1,937.38
| Professional | | $142.31 | $1,226.25 | $1,937.38 |