- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.95 / $188.72 / $1,136.45
| Professional | | $176.95 | $188.72 | $1,136.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.48 / $231.65 / $281.12
| Professional | | $177.48 | $231.65 | $281.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.82 / $299.02 / $351.22
| Professional | | $182.82 | $299.02 | $351.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.36 / $219.36 / $305.27
| Professional | | $1.36 | $219.36 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.36 / $175.61 / $274.20
| Professional | | $1.36 | $175.61 | $274.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.02 / $206.23 / $370.58
| Professional | | $169.02 | $206.23 | $370.58 |