- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $190.55 / $1,288.25
| Professional | | $177.83 | $190.55 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $380.19 / $398.11
| Professional | | $354.81 | $380.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $562.34
| Professional | | $295.12 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $288.40 / $1,513.56
| Professional | | $218.78 | $288.40 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $398.11 / $562.34
| Professional | | $346.74 | $398.11 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $489.78
| Professional | | $380.19 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $467.74
| Professional | | $218.78 | $338.84 | $467.74 |