- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.70 / $439.69 / $699.53
| Professional | | $343.70 | $439.69 | $699.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.31 / $583.94 / $848.24
| Professional | | $458.31 | $583.94 | $848.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.34 / $707.69 / $1,090.88
| Professional | | $426.34 | $707.69 | $1,090.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.91 / $657.37 / $1,095.79
| Professional | | $523.91 | $657.37 | $1,095.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.70 / $472.16 / $699.53
| Professional | | $343.70 | $472.16 | $699.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.83 / $760.92 / $1,155.21
| Professional | | $523.83 | $760.92 | $1,155.21 |