- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.56 / $581.28 / $1,513.27
| Professional | | $103.56 | $581.28 | $1,513.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.68 / $158.09 / $1,305.04
| Professional | | $115.68 | $158.09 | $1,305.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.69 / $164.28 / $1,203.28
| Professional | | $129.69 | $164.28 | $1,203.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $849.83 / $1,069.15
| Professional | | $32.34 | $849.83 | $1,069.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.78 / $153.32 / $1,215.58
| Professional | | $123.78 | $153.32 | $1,215.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.90 / $1,013.87 / $1,491.79
| Professional | | $608.90 | $1,013.87 | $1,491.79 |