- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $891.25
| Professional | | $338.84 | $457.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $616.60 / $1,348.96
| Professional | | $331.13 | $616.60 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $812.83
| Professional | | $457.09 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $1,071.52
| Professional | | $309.03 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $891.25
| Professional | | $269.15 | $416.87 | $891.25 |