- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.19 / $391.99 / $568.39
| Professional | | $280.19 | $391.99 | $568.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.24 / $612.07 / $1,665.28
| Professional | | $519.24 | $612.07 | $1,665.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.78 / $609.54 / $1,075.15
| Professional | | $412.78 | $609.54 | $1,075.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.49 / $659.82 / $1,075.15
| Professional | | $437.49 | $659.82 | $1,075.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.73 / $675.29 / $1,963.12
| Professional | | $538.73 | $675.29 | $1,963.12 |