- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.79 / $1,284.08 / $2,677.30
| Professional | | $328.79 | $1,284.08 | $2,677.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.35 / $1,358.78 / $2,224.84
| Professional | | $1,309.35 | $1,358.78 | $2,224.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.28 / $1,402.18 / $3,889.71
| Professional | | $404.28 | $1,402.18 | $3,889.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.79 / $2,130.92 / $2,209.39
| Professional | | $1,606.79 | $2,130.92 | $2,209.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.59 / $1,284.08 / $2,945.03
| Professional | | $347.59 | $1,284.08 | $2,945.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $716.20 / $4,731.80
| Professional | | $5.00 | $716.20 | $4,731.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.57 / $1,432.70 / $4,156.85
| Professional | | $410.57 | $1,432.70 | $4,156.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.64 / $1,335.74 / $1,479.17
| Professional | | $344.64 | $1,335.74 | $1,479.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.24 / $2,260.51 / $3,673.22
| Professional | | $1,512.24 | $2,260.51 | $3,673.22 |