- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $562.34
| Professional | | $257.04 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $616.60 / $616.60
| Professional | | $257.04 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $691.83
| Professional | | $251.19 | $389.05 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $602.56
| Professional | | $269.15 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $363.08 / $645.65
| Professional | | $223.87 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $389.05 / $524.81
| Professional | | $295.12 | $389.05 | $524.81 |