- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.51 / $331.38 / $355.71
| Professional | | $260.51 | $331.38 | $355.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.00 / $355.64 / $503.84
| Professional | | $259.00 | $355.64 | $503.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.51 / $383.73 / $502.24
| Professional | | $284.51 | $383.73 | $502.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.56 / $385.76 / $2,658.16
| Professional | | $311.56 | $385.76 | $2,658.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.91 / $367.39 / $532.50
| Professional | | $293.91 | $367.39 | $532.50 |