- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.37 / $734.34 / $3,744.72
| Professional | | $152.37 | $734.34 | $3,744.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.37 / $418.84 / $5,758.11
| Professional | | $226.37 | $418.84 | $5,758.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.94 / $873.68 / $11,619.90
| Professional | | $329.94 | $873.68 | $11,619.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.64 / $3,831.49 / $11,825.89
| Professional | | $266.64 | $3,831.49 | $11,825.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,574.92 / $7,380.01 / $13,955.18
| Professional | | $5,574.92 | $7,380.01 | $13,955.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.39 / $230.15 / $3,957.71
| Professional | | $164.39 | $230.15 | $3,957.71 |