- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.72 / $312.29 / $417.67
| Professional | | $277.72 | $312.29 | $417.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.79 / $444.91 / $643.77
| Professional | | $343.79 | $444.91 | $643.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.50 / $501.20 / $721.04
| Professional | | $338.50 | $501.20 | $721.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.44 / $486.45 / $746.24
| Professional | | $420.44 | $486.45 | $746.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.72 / $312.29 / $417.67
| Professional | | $277.72 | $312.29 | $417.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.43 / $441.74 / $670.96
| Professional | | $317.43 | $441.74 | $670.96 |