- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.94 / $418.47 / $553.50
| Professional | | $368.94 | $418.47 | $553.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.91 / $388.55 / $2,116.00
| Professional | | $343.91 | $388.55 | $2,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.08 / $518.40 / $1,408.40
| Professional | | $382.08 | $518.40 | $1,408.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.52 / $1,249.54 / $1,249.54
| Professional | | $556.52 | $1,249.54 | $1,249.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.35 / $580.57 / $1,443.95
| Professional | | $410.35 | $580.57 | $1,443.95 |