- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $204.17 / $295.12
| Professional | | $177.83 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $407.38 / $512.86
| Professional | | $371.54 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $436.52
| Professional | | $165.96 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $316.23 / $338.84
| Professional | | $245.47 | $316.23 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $407.38
| Professional | | $229.09 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $338.84 / $338.84
| Professional | | $288.40 | $338.84 | $338.84 |