- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $309.93 / $361.36
| Professional | | $250.14 | $309.93 | $361.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.52 / $397.92 / $629.12
| Professional | | $310.52 | $397.92 | $629.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.76 / $480.49 / $679.02
| Professional | | $343.76 | $480.49 | $679.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.71 / $457.84 / $702.35
| Professional | | $395.71 | $457.84 | $702.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $361.36 / $434.26
| Professional | | $250.14 | $361.36 | $434.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.02 / $416.38 / $625.83
| Professional | | $289.02 | $416.38 | $625.83 |