- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.25 / $424.51 / $657.46
| Professional | | $292.25 | $424.51 | $657.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.00 / $574.00 / $574.00
| Professional | | $574.00 | $574.00 | $574.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.22 / $518.57 / $894.26
| Professional | | $309.22 | $518.57 | $894.26 |
- 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
- $402.00 / $502.77 / $992.03
| Professional | | $402.00 | $502.77 | $992.03 |