- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.04 / $431.45 / $683.64
| Professional | | $362.04 | $431.45 | $683.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.13 / $783.23 / $4,290.00
| Professional | | $320.13 | $783.23 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.20 / $820.01 / $1,163.48
| Professional | | $600.20 | $820.01 | $1,163.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.37 / $404.54 / $774.13
| Professional | | $349.37 | $404.54 | $774.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.07 / $595.85 / $1,080.32
| Professional | | $314.07 | $595.85 | $1,080.32 |