- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.47 / $1,246.21 / $1,945.25
| Professional | | $411.47 | $1,246.21 | $1,945.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.16 / $1,214.40 / $3,326.13
| Professional | | $384.16 | $1,214.40 | $3,326.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.70 / $978.41 / $2,460.40
| Professional | | $864.70 | $978.41 | $2,460.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.51 / $1,111.09 / $1,712.11
| Professional | | $105.51 | $1,111.09 | $1,712.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.49 / $2,160.98 / $3,707.64
| Professional | | $1,311.49 | $2,160.98 | $3,707.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.14 / $766.45 / $766.45
| Professional | | $295.14 | $766.45 | $766.45 |