- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.63 / $330.93 / $373.99
| Professional | | $304.63 | $330.93 | $373.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.23 / $357.02 / $453.42
| Professional | | $290.23 | $357.02 | $453.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.20 / $342.28 / $683.62
| Professional | | $253.20 | $342.28 | $683.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.89 / $355.90 / $589.95
| Professional | | $275.89 | $355.90 | $589.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.92 / $319.27 / $522.20
| Professional | | $249.92 | $319.27 | $522.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.89 / $275.89 / $387.93
| Professional | | $275.89 | $275.89 | $387.93 |