- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.30 / $310.14 / $1,779.55
| Professional | | $230.30 | $310.14 | $1,779.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.67 / $358.67 / $1,230.31
| Professional | | $358.67 | $358.67 | $1,230.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.63 / $471.27 / $1,230.31
| Professional | | $271.63 | $471.27 | $1,230.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.26 / $463.66 / $1,230.31
| Professional | | $306.26 | $463.66 | $1,230.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.81 / $475.40 / $1,510.07
| Professional | | $294.81 | $475.40 | $1,510.07 |