- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $2,884.03 / $4,466.84
| Professional | | $181.97 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $467.74 / $467.74
| Professional | | $70.79 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $3,715.35 / $6,606.93
| Professional | | $218.78 | $3,715.35 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $3,981.07 / $5,888.44
| Professional | | $190.55 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,715.35 / $5,754.40
| Professional | | $229.09 | $3,715.35 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,019.95 / $5,495.41
| Professional | | $229.09 | $3,019.95 | $5,495.41 |