- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.44 / $1,401.27 / $2,157.89
| Professional | | $365.44 | $1,401.27 | $2,157.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.70 / $2,073.79 / $4,685.91
| Professional | | $713.70 | $2,073.79 | $4,685.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.88 / $2,616.23 / $5,780.85
| Professional | | $927.88 | $2,616.23 | $5,780.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.35 / $2,275.80 / $5,022.50
| Professional | | $813.35 | $2,275.80 | $5,022.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,532.31 / $4,303.04 / $6,546.57
| Professional | | $2,532.31 | $4,303.04 | $6,546.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.14 / $3,849.73 / $6,239.04
| Professional | | $1,823.14 | $3,849.73 | $6,239.04 |