- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.61 / $1,825.33 / $2,222.07
| Professional | | $182.61 | $1,825.33 | $2,222.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.57 / $195.97 / $260.27
| Professional | | $186.57 | $195.97 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.71 / $555.17 / $4,341.35
| Professional | | $185.71 | $555.17 | $4,341.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,837.29 / $2,421.38 / $4,294.35
| Professional | | $1,837.29 | $2,421.38 | $4,294.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.31 / $2,386.10 / $4,143.06
| Professional | | $1,625.31 | $2,386.10 | $4,143.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.69 / $2,112.88 / $2,601.00
| Professional | | $174.69 | $2,112.88 | $2,601.00 |