- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.80 / $389.91 / $439.88
| Professional | | $369.80 | $389.91 | $439.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.35 / $535.58 / $1,364.13
| Professional | | $454.35 | $535.58 | $1,364.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.58 / $559.22 / $822.59
| Professional | | $359.58 | $559.22 | $822.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.78 / $520.66 / $822.59
| Professional | | $392.78 | $520.66 | $822.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.86 / $516.66 / $1,501.96
| Professional | | $377.86 | $516.66 | $1,501.96 |