- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.84 / $1,710.50 / $3,046.36
| Professional | | $427.84 | $1,710.50 | $3,046.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.36 / $1,399.53 / $2,935.01
| Professional | | $510.36 | $1,399.53 | $2,935.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.07 / $1,311.65 / $3,656.87
| Professional | | $454.07 | $1,311.65 | $3,656.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.32 / $2,723.90 / $5,958.80
| Professional | | $592.32 | $2,723.90 | $5,958.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.77 / $531.79 / $2,465.73
| Professional | | $460.77 | $531.79 | $2,465.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,788.18
| Professional | | $32.34 | $32.34 | $2,788.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,224.19 / $3,235.07 / $4,965.09
| Professional | | $2,224.19 | $3,235.07 | $4,965.09 |