- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.97 / $478.00 / $720.92
| Professional | | $335.97 | $478.00 | $720.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.07 / $596.42 / $810.58
| Professional | | $392.07 | $596.42 | $810.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $349.54 / $629.54
| Professional | | $32.34 | $349.54 | $629.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.12 / $596.42 / $887.47
| Professional | | $409.12 | $596.42 | $887.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.60 / $756.08 / $1,095.10
| Professional | | $554.60 | $756.08 | $1,095.10 |