- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.12 / $364.25 / $494.22
| Professional | | $320.12 | $364.25 | $494.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.00 / $338.47 / $1,410.00
| Professional | | $321.00 | $338.47 | $1,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.08 / $450.22 / $1,226.24
| Professional | | $324.08 | $450.22 | $1,226.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.34 / $1,118.78 / $1,118.78
| Professional | | $496.34 | $1,118.78 | $1,118.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.30 / $502.98 / $1,292.83
| Professional | | $282.30 | $502.98 | $1,292.83 |