- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.95 / $607.19 / $3,432.24
| Professional | | $279.95 | $607.19 | $3,432.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.25 / $1,077.89 / $3,398.30
| Professional | | $270.25 | $1,077.89 | $3,398.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.50 / $1,594.84 / $3,117.56
| Professional | | $272.50 | $1,594.84 | $3,117.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.30 / $1,902.30 / $2,053.17
| Professional | | $1,902.30 | $1,902.30 | $2,053.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,494.45 / $2,465.11 / $4,043.88
| Professional | | $1,494.45 | $2,465.11 | $4,043.88 |