- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $199.53 / $416.87
| Professional | | $177.83 | $199.53 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $380.19
| Professional | | $158.49 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $275.42 / $426.58
| Professional | | $229.09 | $275.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $239.88 / $371.54
| Professional | | $194.98 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $489.78
| Professional | | $181.97 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $407.38
| Professional | | $194.98 | $281.84 | $407.38 |