- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,288.25 / $3,162.28
| Professional | | $354.81 | $1,288.25 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,548.82 / $2,951.21
| Professional | | $436.52 | $1,548.82 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,445.44
| Professional | | $32.36 | $33.11 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,380.38 / $4,265.80
| Professional | | $512.86 | $1,380.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,348.96 / $3,090.30
| Professional | | $380.19 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,819.70 / $2,884.03
| Professional | | $489.78 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,258.93 / $3,090.30
| Professional | | $354.81 | $1,258.93 | $3,090.30 |