- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.84 / $453.87 / $1,655.91
| Professional | | $223.84 | $453.87 | $1,655.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.47 / $656.16 / $1,661.68
| Professional | | $257.47 | $656.16 | $1,661.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.08 / $487.08 / $2,205.91
| Professional | | $272.08 | $487.08 | $2,205.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.86 / $787.71 / $2,180.94
| Professional | | $258.86 | $787.71 | $2,180.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.84 / $548.74 / $1,791.16
| Professional | | $223.84 | $548.74 | $1,791.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.67 / $1,537.32 / $2,375.19
| Professional | | $1,108.67 | $1,537.32 | $2,375.19 |