- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $457.09 / $3,090.30
| Professional | | $169.82 | $457.09 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $426.58 / $2,951.21
| Professional | | $173.78 | $426.58 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $3,467.37
| Professional | | $239.88 | $363.08 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,584.89 / $3,467.37
| Professional | | $218.78 | $1,584.89 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $512.86 / $3,162.28
| Professional | | $169.82 | $512.86 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $1,584.89 / $3,388.44
| Professional | | $234.42 | $1,584.89 | $3,388.44 |