- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.83 / $362.16 / $573.25
| Professional | | $262.83 | $362.16 | $573.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.82 / $342.14 / $492.79
| Professional | | $290.82 | $342.14 | $492.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.96 / $519.22 / $751.65
| Professional | | $335.96 | $519.22 | $751.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.10 / $478.15 / $848.67
| Professional | | $321.10 | $478.15 | $848.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.83 / $362.16 / $573.25
| Professional | | $262.83 | $362.16 | $573.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.51 / $603.37 / $810.68
| Professional | | $392.51 | $603.37 | $810.68 |