- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.01 / $326.27 / $425.72
| Professional | | $274.01 | $326.27 | $425.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.14 / $432.89 / $660.00
| Professional | | $273.14 | $432.89 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.06 / $509.40 / $924.06
| Professional | | $314.06 | $509.40 | $924.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.05 / $545.91 / $1,068.58
| Professional | | $286.05 | $545.91 | $1,068.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.89 / $526.73 / $1,280.61
| Professional | | $374.89 | $526.73 | $1,280.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.07 / $264.70 / $329.84
| Professional | | $189.07 | $264.70 | $329.84 |