- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $912.01
| Professional | | $302.00 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $977.24
| Professional | | $281.84 | $407.38 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $977.24
| Professional | | $380.19 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $794.33
| Professional | | $331.13 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,096.48
| Professional | | $346.74 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $446.68 / $870.96
| Professional | | $302.00 | $446.68 | $870.96 |