- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.54 / $433.98 / $579.72
| Professional | | $274.54 | $433.98 | $579.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.31 / $287.31 / $287.31
| Professional | | $287.31 | $287.31 | $287.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.00 / $590.00 / $590.00
| Professional | | $590.00 | $590.00 | $590.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $310.38 / $310.38
| Professional | | $310.38 | $310.38 | $310.38 |
- 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
- $295.94 / $395.81 / $978.93
| Professional | | $295.94 | $395.81 | $978.93 |