- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.52 / $409.55 / $415.37
| Professional | | $299.52 | $409.55 | $415.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.29 / $533.15 / $1,268.44
| Professional | | $452.29 | $533.15 | $1,268.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.85 / $585.79 / $765.92
| Professional | | $374.85 | $585.79 | $765.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.17 / $505.37 / $765.92
| Professional | | $351.17 | $505.37 | $765.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.64 / $481.05 / $1,398.46
| Professional | | $437.64 | $481.05 | $1,398.46 |