- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.35 / $632.88 / $632.88
| Professional | | $499.35 | $632.88 | $632.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.04 / $534.99 / $805.00
| Professional | | $438.04 | $534.99 | $805.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.54 / $632.88 / $883.44
| Professional | | $532.54 | $632.88 | $883.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.80 / $510.72 / $794.68
| Professional | | $458.80 | $510.72 | $794.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.35 / $632.88 / $632.88
| Professional | | $499.35 | $632.88 | $632.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.50 / $596.60 / $720.04
| Professional | | $490.50 | $596.60 | $720.04 |