- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.23 / $897.61 / $2,573.05
| Professional | | $482.23 | $897.61 | $2,573.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.17 / $1,014.85 / $2,212.13
| Professional | | $454.17 | $1,014.85 | $2,212.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.41 / $1,732.65 / $3,173.17
| Professional | | $517.41 | $1,732.65 | $3,173.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.50 / $1,099.05 / $2,555.92
| Professional | | $476.50 | $1,099.05 | $2,555.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.23 / $897.61 / $2,573.05
| Professional | | $482.23 | $897.61 | $2,573.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.71 / $2,600.92 / $3,327.21
| Professional | | $1,938.71 | $2,600.92 | $3,327.21 |