- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.50 / $801.19 / $1,104.08
| Professional | | $90.50 | $801.19 | $1,104.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.61 / $194.92 / $1,567.89
| Professional | | $100.61 | $194.92 | $1,567.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.21 / $356.72 / $2,807.69
| Professional | | $112.21 | $356.72 | $2,807.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.00 / $846.69 / $2,796.18
| Professional | | $103.00 | $846.69 | $2,796.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.08 / $1,394.27 / $2,803.58
| Professional | | $888.08 | $1,394.27 | $2,803.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.29 / $654.53 / $1,099.58
| Professional | | $73.29 | $654.53 | $1,099.58 |