- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.43 / $1,377.57 / $1,989.31
| Professional | | $386.43 | $1,377.57 | $1,989.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.49 / $1,256.06 / $3,371.91
| Professional | | $472.49 | $1,256.06 | $3,371.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.97 / $1,334.88 / $3,513.01
| Professional | | $442.97 | $1,334.88 | $3,513.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,494.84 / $20,549.21 / $21,165.69
| Professional | | $5,494.84 | $20,549.21 | $21,165.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.26 / $2,458.42 / $3,742.55
| Professional | | $1,474.26 | $2,458.42 | $3,742.55 |