- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.97 / $303.25 / $464.95
| Professional | | $275.97 | $303.25 | $464.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.23 / $635.64 / $1,332.56
| Professional | | $539.23 | $635.64 | $1,332.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.95 / $483.86 / $860.61
| Professional | | $310.95 | $483.86 | $860.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.93 / $535.45 / $860.61
| Professional | | $340.93 | $535.45 | $860.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.39 / $540.54 / $1,571.39
| Professional | | $441.39 | $540.54 | $1,571.39 |