- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.40 / $424.91 / $501.36
| Professional | | $359.40 | $424.91 | $501.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.29 / $524.29 / $1,549.46
| Professional | | $524.29 | $524.29 | $1,549.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.24 / $598.11 / $862.23
| Professional | | $419.24 | $598.11 | $862.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.24 / $570.05 / $862.23
| Professional | | $459.24 | $570.05 | $862.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.03 / $541.54 / $1,574.32
| Professional | | $432.03 | $541.54 | $1,574.32 |