- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.47 / $364.78 / $426.88
| Professional | | $283.47 | $364.78 | $426.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.63 / $464.11 / $669.02
| Professional | | $358.63 | $464.11 | $669.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.43 / $521.92 / $743.23
| Professional | | $361.43 | $521.92 | $743.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.93 / $505.53 / $775.51
| Professional | | $436.93 | $505.53 | $775.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.47 / $377.95 / $426.88
| Professional | | $283.47 | $377.95 | $426.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.37 / $459.43 / $698.94
| Professional | | $324.37 | $459.43 | $698.94 |