- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $851.14 / $1,479.11
| Professional | | $190.55 | $851.14 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $1,737.80 / $2,041.74
| Professional | | $151.36 | $1,737.80 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $977.24 / $1,288.25
| Facility | | $181.97 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $977.24 / $3,162.28
| Professional | | $524.81 | $977.24 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Professional | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $977.24
| Professional | | $162.18 | $162.18 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $1,047.13 / $1,258.93
| Professional | | $3.98 | $1,047.13 | $1,258.93 |