- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.19 / $374.09 / $410.84
| Professional | | $298.19 | $374.09 | $410.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.71 / $496.71 / $1,307.96
| Professional | | $496.71 | $496.71 | $1,307.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.20 / $492.48 / $807.02
| Professional | | $400.20 | $492.48 | $807.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.16 / $506.29 / $807.02
| Professional | | $373.16 | $506.29 | $807.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.76 / $506.88 / $1,473.55
| Professional | | $392.76 | $506.88 | $1,473.55 |