- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.25 / $3,871.31 / $8,409.34
| Professional | | $722.25 | $3,871.31 | $8,409.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.77 / $3,471.52 / $6,811.50
| Professional | | $942.77 | $3,471.52 | $6,811.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.05 / $2,318.66 / $3,535.31
| Professional | | $326.05 | $2,318.66 | $3,535.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.68 / $4,435.95 / $9,727.87
| Professional | | $1,008.68 | $4,435.95 | $9,727.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,352.43 / $4,375.68 / $6,793.85
| Professional | | $3,352.43 | $4,375.68 | $6,793.85 |