- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.77 / $263.14 / $360.78
| Professional | | $217.77 | $263.14 | $360.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.80 / $351.74 / $492.26
| Professional | | $271.80 | $351.74 | $492.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.75 / $421.62 / $608.91
| Professional | | $287.75 | $421.62 | $608.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.48 / $407.93 / $676.01
| Professional | | $340.48 | $407.93 | $676.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.90 / $315.95 / $513.84
| Professional | | $220.90 | $315.95 | $513.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.58 / $380.76 / $612.98
| Professional | | $262.58 | $380.76 | $612.98 |