- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.95 / $273.51 / $547.80
| Professional | | $181.95 | $273.51 | $547.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.92 / $536.77 / $965.11
| Professional | | $322.92 | $536.77 | $965.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.41 / $675.15 / $1,234.44
| Professional | | $393.41 | $675.15 | $1,234.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.48 / $624.20 / $1,160.27
| Professional | | $399.48 | $624.20 | $1,160.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.06 / $563.51 / $1,423.00
| Professional | | $335.06 | $563.51 | $1,423.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.06 / $504.13 / $1,016.88
| Professional | | $335.06 | $504.13 | $1,016.88 |