- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.31 / $808.48 / $1,497.18
| Professional | | $671.31 | $808.48 | $1,497.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.00 / $904.00 / $904.00
| Professional | | $574.00 | $904.00 | $904.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.77 / $819.68 / $1,211.59
| Professional | | $632.77 | $819.68 | $1,211.59 |
- 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
- $558.30 / $693.46 / $1,086.22
| Professional | | $558.30 | $693.46 | $1,086.22 |