- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.00 / $229.75 / $507.45
| Professional | | $159.00 | $229.75 | $507.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.47 / $223.77 / $392.81
| Professional | | $156.47 | $223.77 | $392.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.16 / $245.88 / $396.33
| Professional | | $161.16 | $245.88 | $396.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.19 / $260.17 / $441.75
| Professional | | $173.19 | $260.17 | $441.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.19 / $259.79 / $294.44
| Professional | | $173.19 | $259.79 | $294.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.56 / $295.39 / $531.73
| Professional | | $223.56 | $295.39 | $531.73 |