- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.66 / $1,832.35 / $2,514.98
| Professional | | $446.66 | $1,832.35 | $2,514.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.91 / $1,244.15 / $3,363.52
| Professional | | $398.91 | $1,244.15 | $3,363.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.55 / $2,073.59 / $2,488.31
| Professional | | $1,621.55 | $2,073.59 | $2,488.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.74 / $855.13 / $3,662.41
| Professional | | $447.74 | $855.13 | $3,662.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.78 / $2,511.52 / $4,513.74
| Professional | | $2,001.78 | $2,511.52 | $4,513.74 |