- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.48 / $961.70 / $1,761.23
| Professional | | $651.48 | $961.70 | $1,761.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $1,743.98 / $3,079.69
| Professional | | $169.88 | $1,743.98 | $3,079.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.63 / $1,230.63 / $1,230.63
| Professional | | $1,230.63 | $1,230.63 | $1,230.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.85 / $1,410.40 / $1,410.40
| Professional | | $143.85 | $1,410.40 | $1,410.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.72 / $1,057.80 / $1,544.99
| Professional | | $850.72 | $1,057.80 | $1,544.99 |