- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.67 / $224.67 / $259.24
| Professional | | $224.67 | $224.67 | $259.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.87 / $215.87 / $338.39
| Facility | | $215.87 | $215.87 | $338.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $215.87 / $230.13
| Professional | | $157.59 | $215.87 | $230.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.87 / $215.87 / $338.39
| Facility | | $215.87 | $215.87 | $338.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $215.87 / $230.13
| Professional | | $157.59 | $215.87 | $230.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.50 / $272.73 / $532.26
| Professional | | $156.50 | $272.73 | $532.26 |