- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.73 / $254.29 / $361.45
| Professional | | $238.73 | $254.29 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.86 / $352.15 / $454.21
| Professional | | $240.86 | $352.15 | $454.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.61 / $380.04 / $630.44
| Professional | | $248.61 | $380.04 | $630.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.21 / $356.55 / $554.79
| Professional | | $250.21 | $356.55 | $554.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.73 / $254.29 / $361.45
| Professional | | $238.73 | $254.29 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.70 / $520.59 / $628.29
| Professional | | $356.70 | $520.59 | $628.29 |