- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.70 / $284.07 / $451.09
| Professional | | $177.70 | $284.07 | $451.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.33 / $300.39 / $490.18
| Professional | | $255.33 | $300.39 | $490.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.38 / $411.58 / $606.00
| Professional | | $247.38 | $411.58 | $606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.30 / $454.78 / $2,492.96
| Professional | | $388.30 | $454.78 | $2,492.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.07 / $416.45 / $604.44
| Professional | | $382.07 | $416.45 | $604.44 |