- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.66 / $944.66 / $1,747.86
| Professional | | $944.66 | $944.66 | $1,747.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.37 / $453.11 / $1,203.67
| Professional | | $259.37 | $453.11 | $1,203.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.10 / $812.40 / $1,040.52
| Professional | | $101.10 | $812.40 | $1,040.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.68 / $1,229.71 / $2,293.60
| Professional | | $795.68 | $1,229.71 | $2,293.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.61 / $1,182.41 / $2,098.29
| Professional | | $503.61 | $1,182.41 | $2,098.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.36 / $956.52 / $1,486.93
| Professional | | $102.36 | $956.52 | $1,486.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.45 / $1,089.18 / $1,938.52
| Professional | | $491.45 | $1,089.18 | $1,938.52 |