- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.00 / $1,456.08 / $11,063.38
| Professional | | $762.00 | $1,456.08 | $11,063.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.06 / $1,607.23 / $8,852.91
| Professional | | $885.06 | $1,607.23 | $8,852.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.88 / $1,638.81 / $11,335.05
| Professional | | $1,036.88 | $1,638.81 | $11,335.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.47 / $2,187.65 / $10,456.48
| Professional | | $948.47 | $2,187.65 | $10,456.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.00 / $1,456.08 / $7,088.94
| Professional | | $762.00 | $1,456.08 | $7,088.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $9,593.14 / $11,644.03
| Professional | | $1,148.40 | $9,593.14 | $11,644.03 |