- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.95 / $2,059.63 / $22,335.10
| Professional | | $871.95 | $2,059.63 | $22,335.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.39 / $998.18 / $9,482.74
| Professional | | $679.39 | $998.18 | $9,482.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.49 / $818.49 / $818.49
| Professional | | $818.49 | $818.49 | $818.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.65 / $5,492.17 / $11,517.80
| Professional | | $727.65 | $5,492.17 | $11,517.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.90 / $1,242.07 / $11,316.94
| Professional | | $697.90 | $1,242.07 | $11,316.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,050.20 / $8,144.50 / $12,588.99
| Professional | | $6,050.20 | $8,144.50 | $12,588.99 |