- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.18 / $209.58 / $3,744.72
| Professional | | $166.18 | $209.58 | $3,744.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.37 / $403.26 / $5,269.01
| Professional | | $226.37 | $403.26 | $5,269.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.05 / $4,554.63 / $7,502.23
| Professional | | $272.05 | $4,554.63 | $7,502.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.51 / $600.87 / $6,636.39
| Professional | | $260.51 | $600.87 | $6,636.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.18 / $183.68 / $3,744.72
| Professional | | $166.18 | $183.68 | $3,744.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,513.89 / $5,633.60 / $7,380.01
| Professional | | $4,513.89 | $5,633.60 | $7,380.01 |