- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.24 / $631.16 / $1,552.51
| Professional | | $84.24 | $631.16 | $1,552.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.73 / $918.62 / $1,687.63
| Professional | | $105.73 | $918.62 | $1,687.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.48 / $751.94 / $955.83
| Professional | | $586.48 | $751.94 | $955.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.78 / $199.86 / $1,697.50
| Professional | | $123.78 | $199.86 | $1,697.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.05 / $1,200.32 / $2,021.82
| Professional | | $801.05 | $1,200.32 | $2,021.82 |