- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.45 / $756.21 / $1,331.65
| Professional | | $675.45 | $756.21 | $1,331.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.72 / $1,780.74 / $2,062.64
| Professional | | $1,511.72 | $1,780.74 | $2,062.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.84 / $1,760.34 / $2,644.95
| Professional | | $1,186.84 | $1,760.34 | $2,644.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.73 / $1,366.85 / $5,712.10
| Professional | | $618.73 | $1,366.85 | $5,712.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.66 / $1,310.26 / $1,729.96
| Professional | | $715.66 | $1,310.26 | $1,729.96 |