- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.25 / $517.74 / $755.92
| Professional | | $289.25 | $517.74 | $755.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.80 / $418.59 / $655.98
| Professional | | $355.80 | $418.59 | $655.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.41 / $729.12 / $1,305.08
| Professional | | $404.41 | $729.12 | $1,305.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.61 / $838.41 / $1,345.98
| Professional | | $412.61 | $838.41 | $1,345.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.25 / $517.74 / $755.92
| Professional | | $289.25 | $517.74 | $755.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.22 / $801.21 / $1,388.24
| Professional | | $526.22 | $801.21 | $1,388.24 |