- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.76 / $327.57 / $415.12
| Professional | | $300.76 | $327.57 | $415.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.42 / $421.48 / $421.48
| Professional | | $351.42 | $421.48 | $421.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.27 / $462.02 / $545.17
| Professional | | $337.27 | $462.02 | $545.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.35 / $444.57 / $853.00
| Professional | | $329.35 | $444.57 | $853.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.20 / $385.71 / $527.80
| Professional | | $284.20 | $385.71 | $527.80 |