- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.17 / $305.14 / $362.15
| Professional | | $249.17 | $305.14 | $362.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.04 / $298.91 / $660.00
| Professional | | $276.04 | $298.91 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.41 / $335.01 / $898.63
| Professional | | $254.41 | $335.01 | $898.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.18 / $818.89 / $818.89
| Professional | | $370.18 | $818.89 | $818.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.47 / $373.22 / $946.30
| Professional | | $261.47 | $373.22 | $946.30 |