- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,412.54 / $3,090.30
| Professional | | $398.11 | $1,412.54 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $912.01 / $2,238.72
| Professional | | $371.54 | $912.01 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $3,019.95
| Professional | | $512.86 | $851.14 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,737.80 / $2,691.53
| Professional | | $436.52 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,659.59 / $3,801.89
| Professional | | $478.63 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,202.26 / $3,162.28
| Professional | | $537.03 | $1,202.26 | $3,162.28 |