- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.46 / $313.31 / $629.80
| Professional | | $226.46 | $313.31 | $629.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.17 / $417.05 / $595.77
| Professional | | $305.17 | $417.05 | $595.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.83 / $482.50 / $777.32
| Professional | | $305.83 | $482.50 | $777.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.13 / $486.68 / $811.26
| Professional | | $349.13 | $486.68 | $811.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.46 / $328.62 / $646.49
| Professional | | $226.46 | $328.62 | $646.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.87 / $542.23 / $811.26
| Professional | | $375.87 | $542.23 | $811.26 |