- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.39 / $515.82 / $613.20
| Professional | | $406.39 | $515.82 | $613.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.82 / $662.36 / $949.25
| Professional | | $511.82 | $662.36 | $949.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.61 / $738.35 / $1,056.43
| Professional | | $509.61 | $738.35 | $1,056.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.95 / $717.28 / $1,100.34
| Professional | | $619.95 | $717.28 | $1,100.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.39 / $557.78 / $613.20
| Professional | | $406.39 | $557.78 | $613.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.13 / $656.05 / $995.27
| Professional | | $463.13 | $656.05 | $995.27 |