- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.89 / $333.92 / $359.85
| Professional | | $311.89 | $333.92 | $359.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.95 / $395.23 / $554.98
| Professional | | $312.95 | $395.23 | $554.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.95 / $308.95 / $699.00
| Facility | | $308.95 | $308.95 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.82 / $430.46 / $600.66
| Professional | | $300.82 | $430.46 | $600.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.05 / $387.73 / $606.73
| Professional | | $301.05 | $387.73 | $606.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.38 / $333.92 / $643.53
| Professional | | $323.38 | $333.92 | $643.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.61 / $404.03 / $538.58
| Professional | | $280.61 | $404.03 | $538.58 |