- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $457.09
| Professional | | $186.21 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $389.05
| Professional | | $173.78 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $446.68
| Professional | | $223.87 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $269.15 / $407.38
| Professional | | $218.78 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $549.54
| Professional | | $186.21 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $446.68
| Professional | | $190.55 | $263.03 | $446.68 |