- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.64 / $432.25 / $1,956.24
| Professional | | $372.64 | $432.25 | $1,956.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.34 / $578.00 / $1,397.97
| Professional | | $490.34 | $578.00 | $1,397.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.61 / $604.78 / $681.84
| Professional | | $338.61 | $604.78 | $681.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.70 / $575.02 / $681.84
| Professional | | $333.70 | $575.02 | $681.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.45 / $525.36 / $1,595.12
| Professional | | $400.45 | $525.36 | $1,595.12 |