- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.65 / $482.72 / $526.59
| Professional | | $399.65 | $482.72 | $526.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.53 / $475.53 / $1,316.76
| Professional | | $475.53 | $475.53 | $1,316.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.50 / $622.80 / $1,316.76
| Professional | | $552.50 | $622.80 | $1,316.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.50 / $622.80 / $1,316.76
| Professional | | $552.50 | $622.80 | $1,316.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.15 / $593.45 / $1,616.18
| Professional | | $511.15 | $593.45 | $1,616.18 |