- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.10 / $341.19 / $627.32
| Professional | | $245.10 | $341.19 | $627.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.40 / $506.42 / $771.17
| Professional | | $255.40 | $506.42 | $771.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.61 / $424.00 / $806.35
| Professional | | $297.61 | $424.00 | $806.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.15 / $498.06 / $498.06
| Professional | | $453.15 | $498.06 | $498.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.66 / $581.19 / $1,262.59
| Professional | | $320.66 | $581.19 | $1,262.59 |