- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.20 / $283.32 / $316.13
| Professional | | $227.20 | $283.32 | $316.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.08 / $306.97 / $431.13
| Professional | | $250.08 | $306.97 | $431.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.33 / $294.17 / $587.78
| Professional | | $218.33 | $294.17 | $587.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.17 / $307.24 / $508.34
| Professional | | $238.17 | $307.24 | $508.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.49 / $287.05 / $486.88
| Professional | | $215.49 | $287.05 | $486.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.82 / $235.82 / $334.67
| Professional | | $235.82 | $235.82 | $334.67 |