- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.22 / $443.30 / $585.32
| Professional | | $337.22 | $443.30 | $585.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.61 / $553.65 / $849.12
| Professional | | $389.61 | $553.65 | $849.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.68 / $562.80 / $1,203.16
| Professional | | $388.68 | $562.80 | $1,203.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,989.00 / $5,098.60 / $5,098.60
| Professional | | $4,989.00 | $5,098.60 | $5,098.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.55 / $582.80 / $1,064.49
| Professional | | $499.55 | $582.80 | $1,064.49 |