- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.12 / $199.90 / $275.47
| Professional | | $164.12 | $199.90 | $275.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.43 / $250.32 / $314.74
| Professional | | $193.43 | $250.32 | $314.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.08 / $308.68 / $451.08
| Professional | | $218.08 | $308.68 | $451.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $288.41 / $501.16
| Professional | | $240.72 | $288.41 | $501.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.12 / $218.64 / $275.47
| Professional | | $164.12 | $218.64 | $275.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.42 / $286.48 / $391.01
| Professional | | $207.42 | $286.48 | $391.01 |