- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.04 / $505.92 / $1,152.22
| Professional | | $404.04 | $505.92 | $1,152.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.42 / $443.24 / $554.04
| Professional | | $359.42 | $443.24 | $554.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.04 / $557.42 / $1,002.00
| Professional | | $404.04 | $557.42 | $1,002.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $619.35 / $1,136.54
| Professional | | $317.58 | $619.35 | $1,136.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.88 / $529.32 / $929.03
| Professional | | $352.88 | $529.32 | $929.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.10 / $583.44 / $1,035.72
| Professional | | $475.10 | $583.44 | $1,035.72 |