- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.85 / $321.58 / $321.58
| Professional | | $231.85 | $321.58 | $321.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.14 / $256.64 / $404.02
| Professional | | $218.14 | $256.64 | $404.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.75 / $321.58 / $453.45
| Professional | | $267.75 | $321.58 | $453.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.44 / $235.37 / $366.24
| Professional | | $211.44 | $235.37 | $366.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.85 / $321.58 / $321.58
| Professional | | $231.85 | $321.58 | $321.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.10 / $306.79 / $396.71
| Professional | | $234.10 | $306.79 | $396.71 |