- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.80 / $400.55 / $508.83
| Professional | | $349.80 | $400.55 | $508.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.00 / $407.20 / $649.94
| Professional | | $324.00 | $407.20 | $649.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.75 / $584.22 / $981.16
| Professional | | $332.75 | $584.22 | $981.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.28 / $893.93 / $3,128.96
| Professional | | $493.28 | $893.93 | $3,128.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.91 / $605.20 / $1,008.17
| Professional | | $475.91 | $605.20 | $1,008.17 |