- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.03 / $235.45 / $323.77
| Professional | | $226.03 | $235.45 | $323.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.73 / $265.10 / $2,368.00
| Professional | | $257.73 | $265.10 | $2,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.85 / $507.06 / $864.49
| Professional | | $226.85 | $507.06 | $864.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.22 / $726.95 / $726.95
| Professional | | $513.22 | $726.95 | $726.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.42 / $443.00 / $880.15
| Professional | | $264.42 | $443.00 | $880.15 |