- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.73 / $289.29 / $380.80
| Professional | | $224.73 | $289.29 | $380.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.56 / $361.73 / $415.99
| Professional | | $271.56 | $361.73 | $415.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.71 / $342.85 / $728.34
| Professional | | $233.71 | $342.85 | $728.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.12 / $289.64 / $394.98
| Professional | | $189.12 | $289.64 | $394.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.06 / $290.12 / $489.49
| Professional | | $208.06 | $290.12 | $489.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.34 / $298.04 / $372.56
| Professional | | $197.34 | $298.04 | $372.56 |