- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.61 / $1,246.77 / $4,379.81
| Professional | | $732.61 | $1,246.77 | $4,379.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.52 / $1,289.53 / $1,890.65
| Professional | | $911.52 | $1,289.53 | $1,890.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.08 / $585.79 / $925.40
| Professional | | $91.08 | $585.79 | $925.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.91 / $1,512.49 / $2,690.66
| Professional | | $1,046.91 | $1,512.49 | $2,690.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.39 / $1,144.65 / $1,702.30
| Professional | | $881.39 | $1,144.65 | $1,702.30 |