- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.05 / $348.78 / $728.54
| Professional | | $279.05 | $348.78 | $728.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.13 / $584.15 / $1,790.07
| Professional | | $481.13 | $584.15 | $1,790.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.99 / $420.42 / $990.66
| Professional | | $300.99 | $420.42 | $990.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.70 / $506.74 / $990.66
| Professional | | $363.70 | $506.74 | $990.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.70 / $484.93 / $1,409.73
| Professional | | $363.70 | $484.93 | $1,409.73 |