- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.01 / $415.50 / $723.59
| Professional | | $362.01 | $415.50 | $723.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.24 / $424.59 / $830.78
| Professional | | $365.24 | $424.59 | $830.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.56 / $460.13 / $700.57
| Professional | | $366.56 | $460.13 | $700.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.92 / $378.31 / $636.84
| Professional | | $299.92 | $378.31 | $636.84 |