- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.08 / $364.18 / $881.31
| Professional | | $206.08 | $364.18 | $881.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.13 / $223.63 / $1,410.00
| Professional | | $217.13 | $223.63 | $1,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.94 / $463.10 / $981.36
| Professional | | $204.94 | $463.10 | $981.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.71 / $795.25 / $795.25
| Professional | | $455.71 | $795.25 | $795.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.85 / $482.34 / $962.84
| Professional | | $279.85 | $482.34 | $962.84 |