- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,445.44
| Professional | | $309.03 | $489.78 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $398.11 / $457.09
| Professional | | $338.84 | $398.11 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $229.09
| Professional | | $181.97 | $181.97 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,380.38
| Professional | | $309.03 | $489.78 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $85.11 / $3,235.94
| Professional | | $77.62 | $85.11 | $3,235.94 |