- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $295.12 / $501.19
| Professional | | $234.42 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $524.81
| Professional | | $245.47 | $309.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $380.19 / $575.44
| Professional | | $295.12 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $707.95
| Professional | | $251.19 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $831.76
| Professional | | $239.88 | $316.23 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $616.60
| Professional | | $251.19 | $323.59 | $616.60 |