- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.18 / $269.39 / $340.74
| Professional | | $231.18 | $269.39 | $340.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.57 / $356.23 / $500.45
| Professional | | $275.57 | $356.23 | $500.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.17 / $408.89 / $584.66
| Professional | | $296.17 | $408.89 | $584.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.07 / $407.44 / $630.66
| Professional | | $340.07 | $407.44 | $630.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.18 / $326.73 / $347.61
| Professional | | $231.18 | $326.73 | $347.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.95 / $356.78 / $570.65
| Professional | | $258.95 | $356.78 | $570.65 |