- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.00 / $277.73 / $327.61
| Professional | | $213.00 | $277.73 | $327.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.38 / $349.91 / $500.41
| Professional | | $270.38 | $349.91 | $500.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.73 / $393.13 / $564.27
| Professional | | $268.73 | $393.13 | $564.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.23 / $376.29 / $577.25
| Professional | | $325.23 | $376.29 | $577.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.00 / $307.05 / $327.61
| Professional | | $213.00 | $307.05 | $327.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.67 / $365.10 / $526.63
| Professional | | $248.67 | $365.10 | $526.63 |