- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $346.74
| Professional | | $181.97 | $213.80 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $173.78 / $416.87
| Professional | | $165.96 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $309.03
| Professional | | $173.78 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $309.03
| Professional | | $181.97 | $223.87 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $309.03
| Professional | | $177.83 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $323.59
| Professional | | $190.55 | $229.09 | $323.59 |