- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $446.68 / $1,258.93
| Professional | | $234.42 | $446.68 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $891.25 / $3,235.94
| Professional | | $190.55 | $891.25 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,041.74
| Professional | | $851.14 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $812.83 / $1,819.70
| Professional | | $263.03 | $812.83 | $1,819.70 |