- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.78 / $425.00 / $522.50
| Professional | | $227.78 | $425.00 | $522.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.74 / $356.86 / $942.36
| Professional | | $302.74 | $356.86 | $942.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.64 / $344.02 / $942.36
| Professional | | $323.64 | $344.02 | $942.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.64 / $343.77 / $942.36
| Professional | | $323.64 | $343.77 | $942.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.19 / $514.66 / $1,244.59
| Professional | | $264.19 | $514.66 | $1,244.59 |