- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.71 / $692.45 / $793.62
| Professional | | $340.71 | $692.45 | $793.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.43 / $528.34 / $891.27
| Professional | | $384.43 | $528.34 | $891.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.80 / $241.14 / $316.67
| Professional | | $26.80 | $241.14 | $316.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.44 / $474.37 / $1,525.52
| Professional | | $394.44 | $474.37 | $1,525.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.99 / $544.62 / $801.00
| Professional | | $304.99 | $544.62 | $801.00 |