- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.25 / $1,583.96 / $3,375.56
| Professional | | $435.25 | $1,583.96 | $3,375.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.19 / $1,906.36 / $4,650.93
| Professional | | $1,460.19 | $1,906.36 | $4,650.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.44 / $533.44 / $2,151.05
| Professional | | $533.44 | $533.44 | $2,151.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.52 / $1,635.56 / $5,468.74
| Professional | | $466.52 | $1,635.56 | $5,468.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.24 / $1,875.43 / $2,664.91
| Professional | | $1,537.24 | $1,875.43 | $2,664.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.55 / $1,928.07 / $2,467.71
| Professional | | $1,150.55 | $1,928.07 | $2,467.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.78 / $2,080.79 / $5,972.84
| Professional | | $625.78 | $2,080.79 | $5,972.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.83 / $1,925.29 / $5,070.35
| Professional | | $1,258.83 | $1,925.29 | $5,070.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.34 / $1,928.07 / $2,739.09
| Professional | | $943.34 | $1,928.07 | $2,739.09 |