- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.66 / $461.25 / $756.47
| Professional | | $366.66 | $461.25 | $756.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.00 / $508.24 / $799.62
| Professional | | $396.00 | $508.24 | $799.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.64 / $597.92 / $1,032.43
| Professional | | $410.64 | $597.92 | $1,032.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.37 / $702.87 / $3,975.04
| Professional | | $465.37 | $702.87 | $3,975.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.65 / $593.79 / $1,011.84
| Professional | | $447.65 | $593.79 | $1,011.84 |