- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.92 / $358.06 / $397.78
| Professional | | $257.92 | $358.06 | $397.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.51 / $473.29 / $1,233.64
| Professional | | $401.51 | $473.29 | $1,233.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.88 / $528.53 / $753.94
| Professional | | $333.88 | $528.53 | $753.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.49 / $496.91 / $753.94
| Professional | | $408.49 | $496.91 | $753.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.06 / $473.54 / $807.91
| Professional | | $396.06 | $473.54 | $807.91 |