- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $741.31 / $5,495.41
| Professional | | $165.96 | $741.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $4,073.80 / $13,803.84
| Professional | | $208.93 | $4,073.80 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $3,090.30 / $11,220.18
| Professional | | $213.80 | $3,090.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $4,677.35 / $8,709.64
| Professional | | $467.74 | $4,677.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $602.56 / $9,120.11
| Professional | | $199.53 | $602.56 | $9,120.11 |