- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.49 / $364.88 / $1,086.94
| Professional | | $328.49 | $364.88 | $1,086.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.93 / $485.93 / $761.50
| Professional | | $485.93 | $485.93 | $761.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.00 / $490.75 / $761.50
| Professional | | $192.00 | $490.75 | $761.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.52 / $522.09 / $761.50
| Professional | | $303.52 | $522.09 | $761.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.55 / $474.07 / $934.65
| Professional | | $301.55 | $474.07 | $934.65 |