- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.68 / $310.57 / $310.57
| Professional | | $235.68 | $310.57 | $310.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.67 / $261.67 / $395.98
| Professional | | $215.67 | $261.67 | $395.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.05 / $310.57 / $434.71
| Professional | | $262.05 | $310.57 | $434.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.40 / $249.79 / $388.67
| Professional | | $224.40 | $249.79 | $388.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.68 / $310.57 / $310.57
| Professional | | $235.68 | $310.57 | $310.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.44 / $294.07 / $388.67
| Professional | | $206.44 | $294.07 | $388.67 |