- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,584.89 / $7,762.47
| Professional | | $380.19 | $1,584.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $4,073.80 / $11,748.98
| Professional | | $524.81 | $4,073.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,288.25 / $5,370.32
| Professional | | $380.19 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,659.59 / $3,388.44
| Professional | | $1,584.89 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,318.26 / $3,715.35
| Professional | | $346.74 | $1,318.26 | $3,715.35 |