- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.92 / $372.28 / $669.39
| Professional | | $326.92 | $372.28 | $669.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.00 / $444.00 / $444.00
| Professional | | $438.00 | $444.00 | $444.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.74 / $397.84 / $578.84
| Professional | | $311.74 | $397.84 | $578.84 |
- 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
- $275.43 / $327.25 / $534.57
| Professional | | $275.43 | $327.25 | $534.57 |