- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.58 / $318.06 / $472.98
| Professional | | $302.58 | $318.06 | $472.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.70 / $253.77 / $375.53
| Professional | | $215.70 | $253.77 | $375.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.27 / $427.50 / $641.94
| Professional | | $305.27 | $427.50 | $641.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.85 / $378.81 / $589.42
| Professional | | $244.85 | $378.81 | $589.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.85 / $302.58 / $472.98
| Professional | | $230.85 | $302.58 | $472.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.64 / $399.68 / $516.83
| Professional | | $275.64 | $399.68 | $516.83 |