- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.36 / $908.92 / $1,454.27
| Professional | | $660.36 | $908.92 | $1,454.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.01 / $771.00 / $1,145.32
| Professional | | $571.01 | $771.00 | $1,145.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.39 / $1,023.89 / $1,782.65
| Professional | | $669.39 | $1,023.89 | $1,782.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.98 / $3,284.20 / $3,851.65
| Professional | | $2,016.98 | $3,284.20 | $3,851.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.34 / $740.83 / $1,213.23
| Professional | | $71.34 | $740.83 | $1,213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.07 / $1,158.61 / $2,159.35
| Professional | | $728.07 | $1,158.61 | $2,159.35 |