- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.62 / $216.60 / $277.14
| Professional | | $197.62 | $216.60 | $277.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.10 / $229.97 / $398.67
| Professional | | $182.10 | $229.97 | $398.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.37 / $300.69 / $369.39
| Professional | | $195.37 | $300.69 | $369.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.22 / $243.22 / $456.35
| Professional | | $210.22 | $243.22 | $456.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.62 / $216.60 / $277.14
| Professional | | $197.62 | $216.60 | $277.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.22 / $296.70 / $450.93
| Professional | | $210.22 | $296.70 | $450.93 |