- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.62 / $228.90 / $2,373.56
| Professional | | $142.62 | $228.90 | $2,373.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.72 / $320.11 / $2,704.72
| Professional | | $182.72 | $320.11 | $2,704.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.88 / $314.99 / $3,972.98
| Professional | | $189.88 | $314.99 | $3,972.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.66 / $323.37 / $2,641.62
| Professional | | $163.66 | $323.37 | $2,641.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.62 / $228.90 / $2,373.56
| Professional | | $142.62 | $228.90 | $2,373.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.66 / $2,764.27 / $3,461.31
| Professional | | $2,027.66 | $2,764.27 | $3,461.31 |