- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.56 / $492.41 / $1,932.55
| Professional | | $356.56 | $492.41 | $1,932.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.14 / $718.43 / $1,830.07
| Professional | | $406.14 | $718.43 | $1,830.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.40 / $1,187.21 / $2,671.44
| Professional | | $404.40 | $1,187.21 | $2,671.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.34 / $725.76 / $1,787.39
| Professional | | $367.34 | $725.76 | $1,787.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.56 / $492.41 / $1,932.55
| Professional | | $356.56 | $492.41 | $1,932.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.01 / $1,861.31 / $2,246.41
| Professional | | $893.01 | $1,861.31 | $2,246.41 |