- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.02 / $238.00 / $328.99
| Professional | | $174.02 | $238.00 | $328.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.29 / $254.86 / $374.84
| Professional | | $181.29 | $254.86 | $374.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.73 / $294.20 / $452.60
| Professional | | $205.73 | $294.20 | $452.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.68 / $2,011.20 / $2,315.48
| Professional | | $1,457.68 | $2,011.20 | $2,315.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.60 / $360.99 / $500.56
| Professional | | $242.60 | $360.99 | $500.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.96 / $259.89 / $324.86
| Professional | | $169.96 | $259.89 | $324.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.16 / $305.63 / $498.95
| Professional | | $217.16 | $305.63 | $498.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.42 / $285.11 / $433.65
| Professional | | $215.42 | $285.11 | $433.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.69 / $259.89 / $363.85
| Professional | | $229.69 | $259.89 | $363.85 |