- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.32 / $1,274.76 / $2,351.56
| Professional | | $384.32 | $1,274.76 | $2,351.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.70 / $1,234.73 / $3,545.04
| Professional | | $357.70 | $1,234.73 | $3,545.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.87 / $999.53 / $2,768.91
| Professional | | $882.87 | $999.53 | $2,768.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.90 / $1,273.18 / $1,838.02
| Professional | | $105.90 | $1,273.18 | $1,838.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.27 / $2,224.92 / $3,997.77
| Professional | | $1,304.27 | $2,224.92 | $3,997.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.10 / $1,040.96 / $1,040.96
| Professional | | $283.10 | $1,040.96 | $1,040.96 |