- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.20 / $447.43 / $2,300.51
| Professional | | $381.20 | $447.43 | $2,300.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.49 / $666.57 / $1,718.74
| Professional | | $565.49 | $666.57 | $1,718.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.61 / $659.04 / $813.43
| Professional | | $420.61 | $659.04 | $813.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.61 / $601.95 / $813.43
| Professional | | $420.61 | $601.95 | $813.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.42 / $520.55 / $1,779.85
| Professional | | $467.42 | $520.55 | $1,779.85 |