- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.57 / $1,321.55 / $2,677.30
| Professional | | $448.57 | $1,321.55 | $2,677.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.29 / $374.23 / $699.82
| Professional | | $102.29 | $374.23 | $699.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.49 / $965.26 / $2,937.13
| Professional | | $365.49 | $965.26 | $2,937.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.57 / $2,101.53 / $2,677.30
| Professional | | $448.57 | $2,101.53 | $2,677.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.22 / $1,175.31 / $1,773.23
| Professional | | $97.22 | $1,175.31 | $1,773.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.17 / $2,674.69 / $3,997.77
| Professional | | $1,783.17 | $2,674.69 | $3,997.77 |