- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.36 / $503.61 / $986.38
| Professional | | $355.36 | $503.61 | $986.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.00 / $651.00 / $651.00
| Professional | | $651.00 | $651.00 | $651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.12 / $598.62 / $1,006.15
| Professional | | $368.12 | $598.62 | $1,006.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.27 / $584.86 / $1,142.49
| Professional | | $454.27 | $584.86 | $1,142.49 |