- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.48 / $1,280.49 / $2,091.08
| Professional | | $265.48 | $1,280.49 | $2,091.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.78 / $1,714.11 / $2,282.51
| Professional | | $236.78 | $1,714.11 | $2,282.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.31 / $990.65 / $1,331.05
| Professional | | $786.31 | $990.65 | $1,331.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.22 / $538.39 / $3,306.21
| Professional | | $257.22 | $538.39 | $3,306.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.53 / $1,554.14 / $2,998.24
| Professional | | $1,333.53 | $1,554.14 | $2,998.24 |