- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $257.89
| Professional | | $225.11 | $225.11 | $257.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.08 / $227.72 / $435.37
| Professional | | $104.08 | $227.72 | $435.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.07 / $304.68 / $401.25
| Professional | | $236.07 | $304.68 | $401.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.55 / $260.87 / $400.19
| Professional | | $202.55 | $260.87 | $400.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $257.89
| Professional | | $225.11 | $225.11 | $257.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.92 / $370.65 / $447.34
| Professional | | $265.92 | $370.65 | $447.34 |