- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.29 / $295.25 / $409.69
| Professional | | $285.29 | $295.25 | $409.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.48 / $325.18 / $4,930.00
| Professional | | $309.48 | $325.18 | $4,930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.80 / $527.73 / $1,101.66
| Professional | | $280.80 | $527.73 | $1,101.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.66 / $898.45 / $898.45
| Professional | | $630.66 | $898.45 | $898.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.88 / $758.88 / $1,087.78
| Professional | | $333.88 | $758.88 | $1,087.78 |