- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.39 / $326.31 / $1,135.61
| Professional | | $255.39 | $326.31 | $1,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.85 / $615.72 / $1,315.03
| Professional | | $340.85 | $615.72 | $1,315.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.36 / $1,165.43 / $1,977.34
| Professional | | $417.36 | $1,165.43 | $1,977.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.77 / $917.46 / $1,648.35
| Professional | | $397.77 | $917.46 | $1,648.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.39 / $291.85 / $1,135.61
| Professional | | $255.39 | $291.85 | $1,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.34 / $1,437.70 / $1,791.06
| Professional | | $1,059.34 | $1,437.70 | $1,791.06 |