- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.74 / $402.00 / $448.00
| Professional | | $368.74 | $402.00 | $448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.76 / $625.65 / $1,385.03
| Professional | | $530.76 | $625.65 | $1,385.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.13 / $580.16 / $839.24
| Professional | | $371.13 | $580.16 | $839.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.47 / $554.25 / $839.24
| Professional | | $446.47 | $554.25 | $839.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.59 / $527.11 / $1,532.36
| Professional | | $448.59 | $527.11 | $1,532.36 |