- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.21 / $227.34 / $288.06
| Professional | | $164.21 | $227.34 | $288.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.76 / $301.45 / $433.83
| Professional | | $223.76 | $301.45 | $433.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.21 / $351.57 / $564.04
| Professional | | $223.21 | $351.57 | $564.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.03 / $355.54 / $592.66
| Professional | | $251.03 | $355.54 | $592.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.21 / $227.34 / $327.72
| Professional | | $164.21 | $227.34 | $327.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.80 / $390.91 / $576.46
| Professional | | $272.80 | $390.91 | $576.46 |