- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $748.88 / $8,741.62
| Professional | | $218.03 | $748.88 | $8,741.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.56 / $2,948.62 / $6,871.98
| Professional | | $219.56 | $2,948.62 | $6,871.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.39 / $4,337.82 / $9,835.17
| Professional | | $305.39 | $4,337.82 | $9,835.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,391.24 / $5,817.16 / $5,817.16
| Professional | | $4,391.24 | $5,817.16 | $5,817.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,782.10 / $6,178.20 / $9,453.48
| Professional | | $3,782.10 | $6,178.20 | $9,453.48 |