- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.35 / $209.35 / $242.38
| Professional | | $209.35 | $209.35 | $242.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.74 / $220.70 / $334.88
| Professional | | $183.74 | $220.70 | $334.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.01 / $233.21 / $373.58
| Professional | | $208.01 | $233.21 | $373.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.22 / $243.70 / $373.85
| Professional | | $189.22 | $243.70 | $373.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.29 / $209.35 / $242.38
| Professional | | $161.29 | $209.35 | $242.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.89 / $230.22 / $336.60
| Professional | | $174.89 | $230.22 | $336.60 |