- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.72 / $1,128.11 / $2,039.98
| Professional | | $221.72 | $1,128.11 | $2,039.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.59 / $204.59 / $1,408.43
| Professional | | $204.59 | $204.59 | $1,408.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.91 / $1,288.96 / $2,579.39
| Professional | | $210.91 | $1,288.96 | $2,579.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.69 / $2,166.77 / $8,737.20
| Professional | | $1,509.69 | $2,166.77 | $8,737.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.31 / $2,026.06 / $2,959.72
| Professional | | $1,404.31 | $2,026.06 | $2,959.72 |