- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $870.96
| Professional | | $263.03 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,023.29
| Professional | | $346.74 | $602.56 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $954.99
| Professional | | $478.63 | $676.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $891.25
| Professional | | $446.68 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $630.96 / $954.99
| Professional | | $79.43 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $954.99
| Professional | | $512.86 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $954.99
| Professional | | $389.05 | $630.96 | $954.99 |