- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.69 / $1,240.25 / $3,769.88
| Professional | | $194.69 | $1,240.25 | $3,769.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.06 / $779.54 / $1,275.60
| Professional | | $176.06 | $779.54 | $1,275.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.89 / $1,156.64 / $2,129.98
| Professional | | $184.89 | $1,156.64 | $2,129.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.53 / $1,677.14 / $4,456.81
| Professional | | $1,333.53 | $1,677.14 | $4,456.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.06 / $1,569.54 / $2,391.73
| Professional | | $1,315.06 | $1,569.54 | $2,391.73 |