- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,096.48 / $7,079.46
| Professional | | $933.25 | $1,096.48 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $776.25
| Professional | | $741.31 | $741.31 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,819.70 / $3,467.37
| Professional | | $1,621.81 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,398.83 / $2,951.21
| Professional | | $2,344.23 | $2,398.83 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,862.09 / $3,235.94
| Professional | | $1,348.96 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,862.09 / $2,884.03
| Professional | | $1,348.96 | $1,862.09 | $2,884.03 |