- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.08 / $268.41 / $2,179.38
| Professional | | $197.08 | $268.41 | $2,179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $385.29 / $1,879.62
| Professional | | $186.64 | $385.29 | $1,879.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.13 / $1,692.53 / $2,201.44
| Professional | | $230.13 | $1,692.53 | $2,201.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.00 / $389.22 / $1,844.52
| Professional | | $197.00 | $389.22 | $1,844.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.08 / $268.41 / $2,179.38
| Professional | | $197.08 | $268.41 | $2,179.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.25 / $2,028.58 / $2,448.29
| Professional | | $1,521.25 | $2,028.58 | $2,448.29 |