- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $2,884.03
| Professional | | $912.01 | $1,047.13 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $912.01 / $1,258.93
| Professional | | $218.78 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $1,479.11
| Professional | | $831.76 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $5,754.40
| Professional | | $1,071.52 | $1,698.24 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $707.95
| Professional | | $32.36 | $33.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,288.25 / $2,137.96
| Professional | | $933.25 | $1,288.25 | $2,137.96 |