- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.70 / $296.95 / $310.20
| Professional | | $262.70 | $296.95 | $310.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.14 / $401.04 / $717.11
| Professional | | $296.14 | $401.04 | $717.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.33 / $447.11 / $625.72
| Professional | | $346.33 | $447.11 | $625.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.54 / $396.32 / $933.42
| Professional | | $342.54 | $396.32 | $933.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.70 / $296.95 / $310.20
| Professional | | $262.70 | $296.95 | $310.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.47 / $383.12 / $561.16
| Professional | | $259.47 | $383.12 | $561.16 |