- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.79 / $331.92 / $622.54
| Professional | | $236.79 | $331.92 | $622.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.91 / $491.61 / $1,448.58
| Professional | | $404.91 | $491.61 | $1,448.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.36 / $479.52 / $1,277.07
| Professional | | $326.36 | $479.52 | $1,277.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.25 / $520.17 / $1,277.07
| Professional | | $334.25 | $520.17 | $1,277.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.66 / $506.94 / $1,473.71
| Professional | | $367.66 | $506.94 | $1,473.71 |