- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.60 / $225.40 / $307.17
| Professional | | $195.60 | $225.40 | $307.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.61 / $232.73 / $347.17
| Professional | | $196.61 | $232.73 | $347.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.43 / $319.54 / $416.50
| Professional | | $230.43 | $319.54 | $416.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.18 / $257.06 / $482.31
| Professional | | $222.18 | $257.06 | $482.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.60 / $225.40 / $307.17
| Professional | | $195.60 | $225.40 | $307.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.55 / $271.45 / $373.36
| Professional | | $184.55 | $271.45 | $373.36 |