- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.20 / $1,153.25 / $5,667.64
| Professional | | $931.20 | $1,153.25 | $5,667.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.57 / $1,540.55 / $2,152.19
| Professional | | $1,157.57 | $1,540.55 | $2,152.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.47 / $603.42 / $960.27
| Professional | | $61.47 | $603.42 | $960.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.05 / $1,726.82 / $2,887.55
| Professional | | $1,298.05 | $1,726.82 | $2,887.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.99 / $1,189.49 / $1,921.50
| Professional | | $914.99 | $1,189.49 | $1,921.50 |