- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.77 / $320.01 / $504.39
| Professional | | $258.77 | $320.01 | $504.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.41 / $388.77 / $545.14
| Professional | | $300.41 | $388.77 | $545.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.38 / $461.06 / $649.65
| Professional | | $322.38 | $461.06 | $649.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.22 / $445.96 / $717.72
| Professional | | $372.22 | $445.96 | $717.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.13 / $356.83 / $534.00
| Professional | | $262.13 | $356.83 | $534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.20 / $404.95 / $650.55
| Professional | | $290.20 | $404.95 | $650.55 |