- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $512.86 / $2,754.23
| Professional | | $181.97 | $512.86 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $416.87 / $2,884.03
| Professional | | $169.82 | $416.87 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $3,467.37
| Professional | | $229.09 | $380.19 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $1,949.84 / $3,388.44
| Professional | | $199.53 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $457.09 / $3,467.37
| Professional | | $199.53 | $457.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $1,513.56 / $3,548.13
| Professional | | $229.09 | $1,513.56 | $3,548.13 |