- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $645.65
| Professional | | $257.04 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $794.33
| Professional | | $331.13 | $524.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $812.83
| Professional | | $478.63 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $645.65
| Professional | | $416.87 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $645.65
| Professional | | $416.87 | $524.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $724.44
| Professional | | $416.87 | $549.54 | $724.44 |