- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.95 / $719.79 / $719.79
| Professional | | $534.95 | $719.79 | $719.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.76 / $625.24 / $916.26
| Professional | | $504.76 | $625.24 | $916.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.20 / $719.79 / $1,028.49
| Professional | | $575.20 | $719.79 | $1,028.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.19 / $596.87 / $928.73
| Professional | | $536.19 | $596.87 | $928.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.95 / $719.79 / $719.79
| Professional | | $534.95 | $719.79 | $719.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.97 / $694.09 / $837.69
| Professional | | $494.97 | $694.09 | $837.69 |