- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $3,630.78 / $9,549.93
| Professional | | $776.25 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,862.09 / $9,120.11
| Professional | | $741.31 | $1,862.09 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $10,715.19
| Professional | | $954.99 | $1,445.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $7,079.46 / $10,964.78
| Professional | | $851.14 | $7,079.46 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $4,073.80 / $15,848.93
| Professional | | $776.25 | $4,073.80 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $11,748.98
| Professional | | $977.24 | $1,949.84 | $11,748.98 |