- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.47 / $1,224.94 / $1,644.80
| Professional | | $174.47 | $1,224.94 | $1,644.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.45 / $1,084.45 / $1,084.45
| Professional | | $1,084.45 | $1,084.45 | $1,084.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.76 / $519.60 / $1,257.05
| Professional | | $164.76 | $519.60 | $1,257.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.66 / $948.98 / $2,507.91
| Professional | | $216.66 | $948.98 | $2,507.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.13 / $1,397.05 / $1,843.21
| Professional | | $1,081.13 | $1,397.05 | $1,843.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.30 / $1,302.22 / $1,969.57
| Professional | | $1,020.30 | $1,302.22 | $1,969.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.76 / $2,152.50 / $4,006.90
| Professional | | $1,327.76 | $2,152.50 | $4,006.90 |