- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.35 / $612.53 / $893.42
| Professional | | $512.35 | $612.53 | $893.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.96 / $535.00 / $951.62
| Professional | | $438.96 | $535.00 | $951.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.28 / $721.86 / $1,117.68
| Professional | | $542.28 | $721.86 | $1,117.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.11 / $411.34 / $690.88
| Professional | | $100.11 | $411.34 | $690.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.82 / $670.24 / $997.16
| Professional | | $531.82 | $670.24 | $997.16 |