- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.56 / $565.09 / $1,449.47
| Professional | | $370.56 | $565.09 | $1,449.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.00 / $589.00 / $589.00
| Professional | | $589.00 | $589.00 | $589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.20 / $591.64 / $1,008.31
| Professional | | $383.20 | $591.64 | $1,008.31 |
- 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
- $504.31 / $644.05 / $1,161.99
| Professional | | $504.31 | $644.05 | $1,161.99 |