- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.39 / $321.08 / $2,715.86
| Professional | | $286.39 | $321.08 | $2,715.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.68 / $458.95 / $3,558.17
| Professional | | $268.68 | $458.95 | $3,558.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.33 / $1,750.15 / $4,434.95
| Professional | | $300.33 | $1,750.15 | $4,434.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.82 / $640.79 / $4,356.91
| Professional | | $277.82 | $640.79 | $4,356.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.39 / $321.08 / $2,715.86
| Professional | | $286.39 | $321.08 | $2,715.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.29 / $2,522.77 / $4,637.58
| Professional | | $1,510.29 | $2,522.77 | $4,637.58 |