- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $537.03
| Professional | | $173.78 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $407.38
| Professional | | $177.83 | $281.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $645.65
| Professional | | $218.78 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $446.68 / $724.44
| Professional | | $218.78 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $891.25
| Professional | | $190.55 | $338.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $660.69
| Professional | | $181.97 | $295.12 | $660.69 |