- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $776.25 / $6,165.95
| Professional | | $181.97 | $776.25 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $3,090.30 / $6,918.31
| Professional | | $245.47 | $3,090.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $3,311.31 / $9,549.93
| Professional | | $302.00 | $3,311.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $8,128.31
| Professional | | $5,128.61 | $5,128.61 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $2,570.40 / $7,943.28
| Professional | | $199.53 | $2,570.40 | $7,943.28 |