- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $436.52
| Professional | | $234.42 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $269.15 / $323.59
| Professional | | $204.17 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $616.60
| Professional | | $229.09 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $426.58
| Professional | | $199.53 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $524.81
| Professional | | $208.93 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $416.87
| Professional | | $199.53 | $302.00 | $416.87 |