- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.95 / $326.27 / $484.46
| Professional | | $235.95 | $326.27 | $484.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.18 / $422.91 / $855.47
| Professional | | $242.18 | $422.91 | $855.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.03 / $478.56 / $635.39
| Professional | | $353.03 | $478.56 | $635.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.53 / $367.30 / $602.09
| Professional | | $220.53 | $367.30 | $602.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.88 / $354.04 / $831.99
| Professional | | $241.88 | $354.04 | $831.99 |