- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $812.83
| Professional | | $316.23 | $398.11 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $691.83
| Professional | | $281.84 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $794.33
| Professional | | $331.13 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $724.44
| Professional | | $398.11 | $489.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $416.87 / $891.25
| Professional | | $316.23 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $794.33
| Professional | | $316.23 | $457.09 | $794.33 |