- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.21 / $366.88 / $2,021.82
| Professional | | $249.21 | $366.88 | $2,021.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.26 / $518.54 / $1,885.23
| Professional | | $295.26 | $518.54 | $1,885.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.14 / $894.88 / $2,750.49
| Professional | | $311.14 | $894.88 | $2,750.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.13 / $523.84 / $1,841.24
| Professional | | $265.13 | $523.84 | $1,841.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.71 / $366.88 / $2,021.82
| Professional | | $235.71 | $366.88 | $2,021.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.59 / $1,926.26 / $2,271.55
| Professional | | $1,404.59 | $1,926.26 | $2,271.55 |