- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.89 / $238.96 / $425.19
| Professional | | $166.89 | $238.96 | $425.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.81 / $264.48 / $385.01
| Professional | | $224.81 | $264.48 | $385.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.03 / $412.38 / $716.80
| Professional | | $234.03 | $412.38 | $716.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.44 / $465.37 / $747.10
| Professional | | $251.44 | $465.37 | $747.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.89 / $238.96 / $425.19
| Professional | | $166.89 | $238.96 | $425.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.67 / $392.44 / $736.87
| Professional | | $274.67 | $392.44 | $736.87 |