- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $446.68
| Professional | | $186.21 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $489.78 / $1,096.48
| Professional | | $223.87 | $489.78 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $831.76 / $1,000.00
| Professional | | $346.74 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $707.95
| Professional | | $446.68 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $2,041.74
| Professional | | $257.04 | $501.19 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $870.96
| Professional | | $323.59 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,230.27 / $1,819.70
| Professional | | $354.81 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $1,819.70
| Professional | | $1,000.00 | $1,445.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $1,047.13
| Professional | | $251.19 | $416.87 | $1,047.13 |