- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.11 / $395.06 / $705.59
| Professional | | $290.11 | $395.06 | $705.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.00 / $659.87 / $1,335.94
| Professional | | $65.00 | $659.87 | $1,335.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.50 / $484.50 / $484.50
| Professional | | $484.50 | $484.50 | $484.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.51 / $629.91 / $629.91
| Professional | | $504.51 | $629.91 | $629.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.47 / $474.13 / $871.72
| Professional | | $333.47 | $474.13 | $871.72 |