- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.04 / $261.88 / $428.74
| Professional | | $195.04 | $261.88 | $428.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.82 / $337.50 / $417.60
| Professional | | $188.82 | $337.50 | $417.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.78 / $275.58 / $377.42
| Professional | | $204.78 | $275.58 | $377.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.55 / $263.55 / $263.55
| Professional | | $263.55 | $263.55 | $263.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.75 / $249.26 / $325.47
| Professional | | $202.75 | $249.26 | $325.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.87 / $271.89 / $548.51
| Professional | | $203.87 | $271.89 | $548.51 |