- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.64 / $390.53 / $553.47
| Professional | | $374.64 | $390.53 | $553.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.86 / $417.75 / $3,307.00
| Professional | | $376.86 | $417.75 | $3,307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.94 / $669.23 / $1,462.04
| Professional | | $378.94 | $669.23 | $1,462.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.29 / $1,249.72 / $1,249.72
| Professional | | $851.29 | $1,249.72 | $1,249.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.73 / $690.69 / $1,513.08
| Professional | | $388.73 | $690.69 | $1,513.08 |