- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.22 / $314.41 / $410.81
| Professional | | $259.22 | $314.41 | $410.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.29 / $259.10 / $573.00
| Professional | | $233.29 | $259.10 | $573.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.92 / $393.67 / $973.34
| Professional | | $248.92 | $393.67 | $973.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.44 / $381.52 / $790.01
| Professional | | $362.44 | $381.52 | $790.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.38 / $425.69 / $960.35
| Professional | | $281.38 | $425.69 | $960.35 |