- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.54 / $431.63 / $619.90
| Professional | | $287.54 | $431.63 | $619.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.36 / $429.84 / $619.95
| Professional | | $365.36 | $429.84 | $619.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.20 / $625.97 / $929.90
| Professional | | $394.20 | $625.97 | $929.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.96 / $595.22 / $1,056.46
| Professional | | $403.96 | $595.22 | $1,056.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.54 / $403.39 / $619.90
| Professional | | $287.54 | $403.39 | $619.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.46 / $634.40 / $859.20
| Professional | | $400.46 | $634.40 | $859.20 |