- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.19 / $292.91 / $383.67
| Professional | | $248.19 | $292.91 | $383.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.60 / $368.31 / $515.83
| Professional | | $284.60 | $368.31 | $515.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.45 / $441.29 / $644.87
| Professional | | $293.45 | $441.29 | $644.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $422.25 / $713.33
| Professional | | $352.43 | $422.25 | $713.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.19 / $314.52 / $383.67
| Professional | | $248.19 | $314.52 | $383.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.89 / $402.81 / $646.86
| Professional | | $260.89 | $402.81 | $646.86 |