- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.63 / $339.63 / $1,536.51
| Professional | | $339.63 | $339.63 | $1,536.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.32 / $251.32 / $251.32
| Professional | | $251.32 | $251.32 | $251.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.86 / $466.26 / $1,534.96
| Professional | | $240.86 | $466.26 | $1,534.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,411.11 / $1,736.75 / $3,907.21
| Professional | | $1,411.11 | $1,736.75 | $3,907.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.15 / $829.17 / $1,462.66
| Professional | | $171.15 | $829.17 | $1,462.66 |