- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.46 / $251.52 / $440.02
| Professional | | $184.46 | $251.52 | $440.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.75 / $266.77 / $382.47
| Professional | | $226.75 | $266.77 | $382.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.68 / $427.96 / $661.82
| Professional | | $246.68 | $427.96 | $661.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.79 / $417.97 / $680.68
| Professional | | $249.79 | $417.97 | $680.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.46 / $251.52 / $440.02
| Professional | | $184.46 | $251.52 | $440.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.25 / $473.24 / $637.74
| Professional | | $284.25 | $473.24 | $637.74 |