- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.76 / $2,716.03 / $5,602.40
| Professional | | $182.76 | $2,716.03 | $5,602.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.23 / $759.93 / $5,510.18
| Professional | | $264.23 | $759.93 | $5,510.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.78 / $2,902.40 / $6,749.16
| Professional | | $244.78 | $2,902.40 | $6,749.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.67 / $4,706.59 / $11,648.37
| Professional | | $306.67 | $4,706.59 | $11,648.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.47 / $273.35 / $4,485.83
| Professional | | $237.47 | $273.35 | $4,485.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $5,175.96
| Professional | | $32.34 | $32.34 | $5,175.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,837.80 / $5,631.36 / $8,657.29
| Professional | | $3,837.80 | $5,631.36 | $8,657.29 |