- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.81 / $252.10 / $281.39
| Professional | | $234.81 | $252.10 | $281.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.55 / $273.48 / $347.32
| Professional | | $221.55 | $273.48 | $347.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.21 / $255.78 / $523.65
| Professional | | $193.21 | $255.78 | $523.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.53 / $271.58 / $450.34
| Professional | | $210.53 | $271.58 | $450.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.18 / $236.25 / $425.52
| Professional | | $182.18 | $236.25 | $425.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.53 / $210.53 / $296.06
| Professional | | $210.53 | $210.53 | $296.06 |