- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.93 / $563.11 / $2,950.33
| Professional | | $325.93 | $563.11 | $2,950.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.93 / $779.27 / $2,870.74
| Professional | | $443.93 | $779.27 | $2,870.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.01 / $776.82 / $3,344.15
| Professional | | $459.01 | $776.82 | $3,344.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.44 / $787.22 / $2,803.77
| Professional | | $398.44 | $787.22 | $2,803.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.93 / $563.11 / $2,950.33
| Professional | | $325.93 | $563.11 | $2,950.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.68 / $2,466.17 / $3,274.16
| Professional | | $1,792.68 | $2,466.17 | $3,274.16 |