- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.48 / $260.14 / $435.29
| Professional | | $182.48 | $260.14 | $435.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.84 / $250.16 / $391.38
| Professional | | $186.84 | $250.16 | $391.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.40 / $259.20 / $417.99
| Professional | | $181.40 | $259.20 | $417.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.50 / $250.40 / $419.03
| Professional | | $161.50 | $250.40 | $419.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.83 / $248.75 / $274.42
| Professional | | $165.83 | $248.75 | $274.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.38 / $290.52 / $508.41
| Professional | | $231.38 | $290.52 | $508.41 |