- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $436.52
| Professional | | $147.91 | $208.93 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $446.68
| Professional | | $186.21 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $467.74
| Professional | | $186.21 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $309.03 / $562.34
| Professional | | $199.53 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $562.34
| Professional | | $158.49 | $251.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $478.63
| Professional | | $158.49 | $239.88 | $478.63 |