- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.12 / $235.77 / $304.14
| Professional | | $197.12 | $235.77 | $304.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.97 / $332.55 / $467.62
| Professional | | $256.97 | $332.55 | $467.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.57 / $369.27 / $527.52
| Professional | | $258.57 | $369.27 | $527.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.33 / $369.13 / $566.26
| Professional | | $308.33 | $369.13 | $566.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.12 / $285.45 / $464.68
| Professional | | $197.12 | $285.45 | $464.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.74 / $312.54 / $493.19
| Professional | | $219.74 | $312.54 | $493.19 |