- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $251.50 / $251.50
| Professional | | $186.64 | $251.50 | $251.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $277.33 / $400.58
| Professional | | $240.72 | $277.33 | $400.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.18 / $309.22 / $463.66
| Professional | | $256.18 | $309.22 | $463.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.33 / $296.64 / $455.07
| Professional | | $230.33 | $296.64 | $455.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $251.50 / $251.50
| Professional | | $186.64 | $251.50 | $251.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.39 / $311.18 / $424.30
| Professional | | $256.39 | $311.18 | $424.30 |