- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.28 / $540.66 / $1,119.83
| Professional | | $369.28 | $540.66 | $1,119.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.00 / $638.00 / $638.00
| Professional | | $638.00 | $638.00 | $638.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.46 / $524.61 / $725.05
| Professional | | $338.46 | $524.61 | $725.05 |
- 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
- $424.50 / $597.48 / $1,186.52
| Professional | | $424.50 | $597.48 | $1,186.52 |