- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $2,691.53 / $4,168.69
| Professional | | $181.97 | $2,691.53 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $316.23 / $5,623.41
| Professional | | $194.98 | $316.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $630.96 / $6,918.31
| Professional | | $229.09 | $630.96 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $2,884.03 / $6,760.83
| Professional | | $204.17 | $2,884.03 | $6,760.83 |