- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $707.95
| Professional | | $309.03 | $426.58 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $1,000.00
| Professional | | $281.84 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $1,023.29
| Professional | | $389.05 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $954.99
| Professional | | $380.19 | $489.78 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $1,096.48
| Professional | | $363.08 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,071.52
| Professional | | $346.74 | $524.81 | $1,071.52 |