- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $3,388.44 / $6,309.57
| Professional | | $741.31 | $3,388.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $2,951.21 / $10,232.93
| Professional | | $812.83 | $2,951.21 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,897.79 / $6,760.83
| Professional | | $3,801.89 | $4,897.79 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $4,168.69 / $10,715.19
| Professional | | $645.65 | $4,168.69 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,187.76 / $7,762.47
| Professional | | $660.69 | $2,187.76 | $7,762.47 |