- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.90 / $253.90 / $267.22
| Professional | | $253.90 | $253.90 | $267.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.97 / $329.09 / $487.71
| Professional | | $273.97 | $329.09 | $487.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.43 / $380.85 / $553.53
| Professional | | $316.43 | $380.85 | $553.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.17 / $363.41 / $557.50
| Professional | | $282.17 | $363.41 | $557.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.90 / $253.90 / $267.22
| Professional | | $253.90 | $253.90 | $267.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.44 / $373.06 / $507.69
| Professional | | $296.44 | $373.06 | $507.69 |