- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.45 / $355.07 / $542.21
| Professional | | $263.45 | $355.07 | $542.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.45 / $372.29 / $538.58
| Professional | | $316.45 | $372.29 | $538.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.32 / $546.85 / $805.58
| Professional | | $346.32 | $546.85 | $805.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $515.25 / $914.52
| Professional | | $352.43 | $515.25 | $914.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.45 / $355.07 / $542.21
| Professional | | $263.45 | $355.07 | $542.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.90 / $570.69 / $776.98
| Professional | | $408.90 | $570.69 | $776.98 |