- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.67 / $1,275.42 / $3,140.95
| Professional | | $673.67 | $1,275.42 | $3,140.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.76 / $1,762.19 / $2,920.89
| Professional | | $483.76 | $1,762.19 | $2,920.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.48 / $994.12 / $1,317.76
| Professional | | $82.48 | $994.12 | $1,317.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.30 / $1,375.58 / $4,190.12
| Professional | | $518.30 | $1,375.58 | $4,190.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.22 / $2,352.11 / $3,289.82
| Professional | | $1,463.22 | $2,352.11 | $3,289.82 |