- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.40 / $1,459.55 / $4,029.12
| Professional | | $695.40 | $1,459.55 | $4,029.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.73 / $967.42 / $1,454.59
| Professional | | $824.73 | $967.42 | $1,454.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.89 / $1,441.80 / $2,700.33
| Professional | | $716.89 | $1,441.80 | $2,700.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.47 / $1,472.34 / $3,159.35
| Professional | | $11.47 | $1,472.34 | $3,159.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $995.46 / $4,739.03
| Professional | | $7.80 | $995.46 | $4,739.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.34 / $1,887.04 / $3,049.76
| Professional | | $1,397.34 | $1,887.04 | $3,049.76 |