- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $2,951.21 / $5,888.44
| Professional | | $186.21 | $2,951.21 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $3,467.37 / $6,760.83
| Professional | | $251.19 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $501.19
| Professional | | $32.36 | $33.11 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $7,585.78
| Professional | | $302.00 | $467.74 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $3,630.78 / $9,332.54
| Professional | | $223.87 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $4,677.35 / $7,244.36
| Professional | | $288.40 | $4,677.35 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $3,235.94 / $6,760.83
| Professional | | $208.93 | $3,235.94 | $6,760.83 |