- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $446.68 / $1,995.26
| Professional | | $186.21 | $446.68 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $389.05 / $1,905.46
| Professional | | $158.49 | $389.05 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,698.24 / $2,187.76
| Professional | | $229.09 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $1,122.02 / $2,238.72
| Professional | | $194.98 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $467.74 / $2,187.76
| Professional | | $158.49 | $467.74 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,288.25 / $2,454.71
| Professional | | $229.09 | $1,288.25 | $2,454.71 |