- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.29 / $210.44 / $239.32
| Professional | | $161.29 | $210.44 | $239.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.16 / $261.62 / $381.85
| Professional | | $202.16 | $261.62 | $381.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.47 / $289.92 / $425.39
| Professional | | $207.47 | $289.92 | $425.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.38 / $288.52 / $442.62
| Professional | | $249.38 | $288.52 | $442.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.29 / $207.97 / $239.32
| Professional | | $161.29 | $207.97 | $239.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.17 / $251.10 / $404.94
| Professional | | $173.17 | $251.10 | $404.94 |