- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.70 / $778.08 / $3,246.76
| Professional | | $580.70 | $778.08 | $3,246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.26 / $754.58 / $1,034.00
| Professional | | $693.26 | $754.58 | $1,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.16 / $903.75 / $1,325.30
| Professional | | $580.16 | $903.75 | $1,325.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $861.01 / $3,001.38
| Professional | | $16.76 | $861.01 | $3,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.40 / $761.60 / $4,739.03
| Professional | | $11.40 | $761.60 | $4,739.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.04 / $939.58 / $1,447.12
| Professional | | $707.04 | $939.58 | $1,447.12 |