- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.80 / $437.33 / $580.25
| Professional | | $319.80 | $437.33 | $580.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.52 / $600.41 / $1,797.81
| Professional | | $494.52 | $600.41 | $1,797.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.50 / $584.94 / $1,515.35
| Professional | | $396.50 | $584.94 | $1,515.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.25 / $617.90 / $1,515.35
| Professional | | $399.25 | $617.90 | $1,515.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.79 / $605.04 / $1,758.93
| Professional | | $453.79 | $605.04 | $1,758.93 |