- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.18 / $281.62 / $460.24
| Professional | | $250.18 | $281.62 | $460.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.75 / $381.44 / $513.23
| Professional | | $294.75 | $381.44 | $513.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.39 / $357.71 / $637.74
| Professional | | $243.39 | $357.71 | $637.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.47 / $399.53 / $591.88
| Professional | | $333.47 | $399.53 | $591.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.18 / $306.82 / $460.24
| Professional | | $250.18 | $306.82 | $460.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.77 / $344.88 / $570.41
| Professional | | $251.77 | $344.88 | $570.41 |