- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.75 / $1,128.11 / $1,705.93
| Professional | | $183.75 | $1,128.11 | $1,705.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.11 / $1,758.76 / $2,627.54
| Professional | | $958.11 | $1,758.76 | $2,627.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.90 / $1,075.95 / $2,393.41
| Professional | | $192.90 | $1,075.95 | $2,393.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.08 / $1,783.08 / $1,841.08
| Professional | | $1,783.08 | $1,783.08 | $1,841.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.37 / $1,612.84 / $1,612.84
| Professional | | $201.37 | $1,612.84 | $1,612.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.80 / $1,128.11 / $3,494.00
| Professional | | $183.80 | $1,128.11 | $3,494.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.74 / $361.54 / $2,049.44
| Professional | | $167.74 | $361.54 | $2,049.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.45 / $1,108.22 / $2,393.41
| Professional | | $198.45 | $1,108.22 | $2,393.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.55 / $195.49 / $1,272.78
| Professional | | $174.55 | $195.49 | $1,272.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.87 / $1,810.19 / $2,778.22
| Professional | | $1,362.87 | $1,810.19 | $2,778.22 |