- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.80 / $233.30 / $262.64
| Professional | | $211.80 | $233.30 | $262.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.14 / $235.60 / $317.93
| Professional | | $196.14 | $235.60 | $317.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.39 / $285.58 / $409.15
| Professional | | $215.39 | $285.58 | $409.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.75 / $240.37 / $368.74
| Professional | | $207.75 | $240.37 | $368.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.80 / $233.30 / $262.64
| Professional | | $211.80 | $233.30 | $262.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.90 / $290.45 / $380.03
| Professional | | $224.90 | $290.45 | $380.03 |