- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.80 / $259.23 / $300.08
| Professional | | $201.80 | $259.23 | $300.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.38 / $326.61 / $459.24
| Professional | | $252.38 | $326.61 | $459.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.63 / $365.51 / $532.84
| Professional | | $261.63 | $365.51 | $532.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.10 / $365.80 / $561.15
| Professional | | $314.10 | $365.80 | $561.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.80 / $260.68 / $300.08
| Professional | | $201.80 | $260.68 | $300.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.40 / $307.98 / $506.31
| Professional | | $212.40 | $307.98 | $506.31 |