- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $741.31 / $3,981.07
| Professional | | $165.96 | $741.31 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $426.58 / $3,388.44
| Professional | | $199.53 | $426.58 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $457.09 / $4,265.80
| Professional | | $251.19 | $457.09 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $2,691.53 / $4,786.30
| Professional | | $239.88 | $2,691.53 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $741.31 / $6,309.57
| Professional | | $165.96 | $741.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $1,737.80 / $5,128.61
| Professional | | $251.19 | $1,737.80 | $5,128.61 |