- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.29 / $346.90 / $435.98
| Professional | | $204.29 | $346.90 | $435.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.76 / $389.06 / $588.79
| Professional | | $325.76 | $389.06 | $588.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.83 / $494.29 / $813.89
| Professional | | $357.83 | $494.29 | $813.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.11 / $475.27 / $739.52
| Professional | | $382.11 | $475.27 | $739.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.29 / $346.90 / $435.98
| Professional | | $204.29 | $346.90 | $435.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.67 / $585.71 / $752.15
| Professional | | $381.67 | $585.71 | $752.15 |