- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.27 / $330.18 / $330.18
| Professional | | $289.27 | $330.18 | $330.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.00 / $358.57 / $491.15
| Professional | | $310.00 | $358.57 | $491.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.38 / $419.38 / $1,100.30
| Facility | | $419.38 | $419.38 | $1,100.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $406.00
| Professional | | $375.00 | $375.00 | $406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $366.95 / $545.96
| Professional | | $260.74 | $366.95 | $545.96 |