- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.98 / $1,240.25 / $3,803.17
| Professional | | $221.98 | $1,240.25 | $3,803.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.49 / $335.50 / $2,474.16
| Professional | | $245.49 | $335.50 | $2,474.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.93 / $358.80 / $2,193.10
| Professional | | $283.93 | $358.80 | $2,193.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,742.67 / $1,941.83
| Professional | | $32.34 | $1,742.67 | $1,941.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.12 / $328.02 / $2,250.15
| Professional | | $272.12 | $328.02 | $2,250.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.38 / $2,120.96 / $3,041.44
| Professional | | $1,458.38 | $2,120.96 | $3,041.44 |