- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.83 / $324.45 / $726.75
| Professional | | $276.83 | $324.45 | $726.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.00 / $466.22 / $1,428.70
| Professional | | $384.00 | $466.22 | $1,428.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.51 / $412.55 / $946.57
| Professional | | $289.51 | $412.55 | $946.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $476.85 / $946.57
| Professional | | $354.81 | $476.85 | $946.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.62 / $431.88 / $1,378.43
| Professional | | $355.62 | $431.88 | $1,378.43 |