- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.68 / $1,308.07 / $6,270.76
| Professional | | $776.68 | $1,308.07 | $6,270.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.86 / $1,308.07 / $1,811.17
| Professional | | $421.86 | $1,308.07 | $1,811.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $150.16 / $1,388.66
| Professional | | $32.34 | $150.16 | $1,388.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.82 / $1,434.63 / $1,811.17
| Professional | | $715.82 | $1,434.63 | $1,811.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.50 / $1,215.93 / $2,123.90
| Professional | | $828.50 | $1,215.93 | $2,123.90 |