- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.13 / $347.93 / $586.35
| Professional | | $288.13 | $347.93 | $586.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.87 / $330.96 / $400.23
| Professional | | $307.87 | $330.96 | $400.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.11 / $700.00 / $1,044.33
| Professional | | $317.11 | $700.00 | $1,044.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $310.38 / $310.38
| Professional | | $310.38 | $310.38 | $310.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.59 / $351.43 / $537.75
| Professional | | $254.59 | $351.43 | $537.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.01 / $496.77 / $885.59
| Professional | | $335.01 | $496.77 | $885.59 |