- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.84 / $188.12 / $315.25
| Professional | | $165.84 | $188.12 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.41 / $271.80 / $424.18
| Professional | | $184.41 | $271.80 | $424.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.05 / $283.39 / $402.32
| Professional | | $214.05 | $283.39 | $402.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.18 / $275.79 / $497.50
| Professional | | $229.18 | $275.79 | $497.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.84 / $188.12 / $315.25
| Professional | | $165.84 | $188.12 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.52 / $266.19 / $476.13
| Professional | | $194.52 | $266.19 | $476.13 |