- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.85 / $339.31 / $532.78
| Professional | | $248.85 | $339.31 | $532.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.69 / $354.93 / $509.31
| Professional | | $301.69 | $354.93 | $509.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.47 / $516.51 / $784.92
| Professional | | $327.47 | $516.51 | $784.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.82 / $495.46 / $879.39
| Professional | | $331.82 | $495.46 | $879.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.45 / $339.31 / $532.78
| Professional | | $268.45 | $339.31 | $532.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.29 / $557.72 / $823.41
| Professional | | $362.29 | $557.72 | $823.41 |