- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.69 / $360.50 / $727.68
| Professional | | $242.69 | $360.50 | $727.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.00 / $545.00 / $545.00
| Professional | | $545.00 | $545.00 | $545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.08 / $481.39 / $758.83
| Professional | | $325.08 | $481.39 | $758.83 |
- 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
- $333.10 / $444.50 / $988.28
| Professional | | $333.10 | $444.50 | $988.28 |