- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,380.38 / $3,162.28
| Professional | | $323.59 | $1,380.38 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $6,606.93
| Professional | | $2,884.03 | $2,884.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $891.25 / $5,128.61
| Professional | | $446.68 | $891.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $6,606.93
| Professional | | $3,019.95 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,949.84 / $4,677.35
| Professional | | $363.08 | $1,949.84 | $4,677.35 |