- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.47 / $480.04 / $519.78
| Professional | | $358.47 | $480.04 | $519.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.00 / $404.00 / $1,441.12
| Professional | | $404.00 | $404.00 | $1,441.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.60 / $694.86 / $904.65
| Professional | | $448.60 | $694.86 | $904.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.32 / $607.60 / $904.65
| Professional | | $420.32 | $607.60 | $904.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.07 / $568.19 / $1,651.77
| Professional | | $548.07 | $568.19 | $1,651.77 |