- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.76 / $3,632.25 / $3,969.71
| Professional | | $205.76 | $3,632.25 | $3,969.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.07 / $315.80 / $5,623.81
| Professional | | $195.07 | $315.80 | $5,623.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.92 / $2,878.33 / $7,532.92
| Professional | | $239.92 | $2,878.33 | $7,532.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,908.32 / $5,037.81 / $6,918.33
| Professional | | $3,908.32 | $5,037.81 | $6,918.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,854.78 / $3,849.39 / $6,005.05
| Professional | | $2,854.78 | $3,849.39 | $6,005.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,504.14 / $4,971.42 / $9,269.46
| Professional | | $3,504.14 | $4,971.42 | $9,269.46 |