- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.00 / $315.11 / $1,045.20
| Professional | | $183.00 | $315.11 | $1,045.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.28 / $373.38 / $637.73
| Professional | | $193.28 | $373.38 | $637.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.10 / $605.77 / $970.95
| Professional | | $328.10 | $605.77 | $970.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.20 / $703.06 / $1,477.84
| Professional | | $421.20 | $703.06 | $1,477.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.03 / $609.02 / $915.79
| Professional | | $408.03 | $609.02 | $915.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.20 / $703.06 / $907.20
| Professional | | $421.20 | $703.06 | $907.20 |