- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.54 / $228.24 / $265.43
| Professional | | $216.54 | $228.24 | $265.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.89 / $284.67 / $402.49
| Professional | | $238.89 | $284.67 | $402.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.86 / $356.48 / $561.79
| Professional | | $267.86 | $356.48 | $561.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $318.63 / $495.79
| Professional | | $261.33 | $318.63 | $495.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.54 / $228.24 / $265.43
| Professional | | $216.54 | $228.24 | $265.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $351.48 / $516.05
| Professional | | $261.33 | $351.48 | $516.05 |