- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.31 / $1,107.35 / $1,565.39
| Professional | | $157.31 | $1,107.35 | $1,565.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.95 / $944.85 / $2,199.12
| Professional | | $178.95 | $944.85 | $2,199.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.75 / $787.24 / $1,587.62
| Professional | | $734.75 | $787.24 | $1,587.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.42 / $1,270.60 / $1,657.34
| Professional | | $953.42 | $1,270.60 | $1,657.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.70 / $1,664.26 / $2,865.11
| Professional | | $1,166.70 | $1,664.26 | $2,865.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.87 / $935.87 / $935.87
| Professional | | $146.87 | $935.87 | $935.87 |