- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.93 / $220.14 / $299.43
| Professional | | $188.93 | $220.14 | $299.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.96 / $226.69 / $336.99
| Professional | | $190.96 | $226.69 | $336.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.67 / $311.18 / $404.48
| Professional | | $223.67 | $311.18 | $404.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.41 / $250.39 / $469.78
| Professional | | $216.41 | $250.39 | $469.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.93 / $220.14 / $299.43
| Professional | | $188.93 | $220.14 | $299.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.11 / $270.89 / $385.07
| Professional | | $180.11 | $270.89 | $385.07 |