- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.38 / $226.37 / $226.37
| Professional | | $131.38 | $226.37 | $226.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.55 / $253.08 / $384.69
| Professional | | $212.55 | $253.08 | $384.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.54 / $280.38 / $419.28
| Professional | | $215.54 | $280.38 | $419.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.29 / $287.58 / $441.17
| Professional | | $223.29 | $287.58 | $441.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.38 / $226.37 / $226.37
| Professional | | $131.38 | $226.37 | $226.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.36 / $293.02 / $387.09
| Professional | | $219.36 | $293.02 | $387.09 |