- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.58 / $498.63 / $785.21
| Professional | | $319.58 | $498.63 | $785.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.11 / $541.30 / $770.42
| Professional | | $460.11 | $541.30 | $770.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.83 / $782.78 / $1,192.97
| Professional | | $458.83 | $782.78 | $1,192.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.65 / $764.63 / $1,357.14
| Professional | | $508.65 | $764.63 | $1,357.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.57 / $498.63 / $785.21
| Professional | | $331.57 | $498.63 | $785.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.26 / $812.25 / $1,252.33
| Professional | | $502.26 | $812.25 | $1,252.33 |