- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.22 / $431.42 / $1,143.78
| Professional | | $396.22 | $431.42 | $1,143.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.65 / $469.48 / $630.00
| Professional | | $454.65 | $469.48 | $630.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.60 / $545.15 / $1,121.69
| Professional | | $387.60 | $545.15 | $1,121.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.30 / $592.01 / $963.16
| Professional | | $455.30 | $592.01 | $963.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.67 / $507.71 / $894.89
| Professional | | $358.67 | $507.71 | $894.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.96 / $523.60 / $635.44
| Professional | | $392.96 | $523.60 | $635.44 |