- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.62 / $319.45 / $488.07
| Professional | | $237.62 | $319.45 | $488.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.50 / $331.17 / $472.10
| Professional | | $281.50 | $331.17 | $472.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.42 / $478.98 / $792.74
| Professional | | $298.42 | $478.98 | $792.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.33 / $505.77 / $840.20
| Professional | | $308.33 | $505.77 | $840.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.62 / $319.45 / $488.07
| Professional | | $237.62 | $319.45 | $488.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.96 / $519.69 / $832.52
| Professional | | $350.96 | $519.69 | $832.52 |