- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.75 / $453.52 / $787.27
| Professional | | $423.75 | $453.52 | $787.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.57 / $576.38 / $817.06
| Professional | | $491.57 | $576.38 | $817.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.66 / $689.79 / $988.24
| Professional | | $529.66 | $689.79 | $988.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.35 / $617.13 / $946.71
| Professional | | $514.35 | $617.13 | $946.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.75 / $453.52 / $787.27
| Professional | | $423.75 | $453.52 | $787.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.85 / $701.18 / $922.83
| Professional | | $454.85 | $701.18 | $922.83 |