- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.22 / $489.47 / $744.85
| Professional | | $337.22 | $489.47 | $744.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.00 / $602.00 / $602.00
| Professional | | $602.00 | $602.00 | $602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.31 / $592.08 / $1,023.06
| Professional | | $352.31 | $592.08 | $1,023.06 |
- 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
- $471.80 / $582.80 / $1,124.32
| Professional | | $471.80 | $582.80 | $1,124.32 |