- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.89 / $365.95 / $582.94
| Professional | | $221.89 | $365.95 | $582.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.30 / $488.45 / $1,406.47
| Professional | | $402.30 | $488.45 | $1,406.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.13 / $493.77 / $1,380.33
| Professional | | $306.13 | $493.77 | $1,380.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.63 / $543.21 / $1,380.33
| Professional | | $315.63 | $543.21 | $1,380.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.46 / $441.03 / $1,549.25
| Professional | | $380.46 | $441.03 | $1,549.25 |