- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.69 / $256.23 / $1,181.68
| Professional | | $207.69 | $256.23 | $1,181.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.76 / $329.58 / $1,135.59
| Professional | | $194.76 | $329.58 | $1,135.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.51 / $343.78 / $1,408.96
| Professional | | $217.51 | $343.78 | $1,408.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.50 / $460.15 / $1,390.52
| Professional | | $199.50 | $460.15 | $1,390.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.82 / $256.23 / $1,181.68
| Professional | | $192.82 | $256.23 | $1,181.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.32 / $1,120.22 / $1,586.14
| Professional | | $796.32 | $1,120.22 | $1,586.14 |