- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.43 / $329.85 / $424.01
| Professional | | $259.43 | $329.85 | $424.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.61 / $413.62 / $578.72
| Professional | | $319.61 | $413.62 | $578.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.03 / $487.65 / $712.61
| Professional | | $331.03 | $487.65 | $712.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.36 / $476.08 / $788.68
| Professional | | $397.36 | $476.08 | $788.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.43 / $323.97 / $424.01
| Professional | | $259.43 | $323.97 | $424.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.33 / $446.45 / $715.26
| Professional | | $288.33 | $446.45 | $715.26 |