- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.53 / $265.27 / $1,200.00
| Professional | | $209.53 | $265.27 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.09 / $199.09 / $199.09
| Professional | | $199.09 | $199.09 | $199.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.99 / $527.16 / $619.00
| Professional | | $456.99 | $527.16 | $619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.70 / $445.58 / $714.69
| Professional | | $378.70 | $445.58 | $714.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.09 / $510.86 / $699.27
| Professional | | $199.09 | $510.86 | $699.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.71 / $565.32 / $666.09
| Professional | | $400.71 | $565.32 | $666.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.31 / $328.41 / $747.93
| Professional | | $280.31 | $328.41 | $747.93 |