- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.68 / $1,449.27 / $6,808.46
| Professional | | $1,151.68 | $1,449.27 | $6,808.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.30 / $1,620.77 / $2,178.81
| Professional | | $1,354.30 | $1,620.77 | $2,178.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.58 / $1,897.83 / $2,866.69
| Professional | | $1,265.58 | $1,897.83 | $2,866.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.10 / $1,432.82 / $2,414.39
| Professional | | $44.10 | $1,432.82 | $2,414.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $1,194.02 / $2,367.05
| Professional | | $30.00 | $1,194.02 | $2,367.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.07 / $1,910.15 / $2,884.84
| Professional | | $1,511.07 | $1,910.15 | $2,884.84 |