- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.81 / $245.75 / $396.08
| Professional | | $176.81 | $245.75 | $396.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.65 / $355.65 / $355.65
| Professional | | $355.65 | $355.65 | $355.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.51 / $308.13 / $657.75
| Professional | | $193.51 | $308.13 | $657.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.67 / $259.55 / $533.40
| Professional | | $194.67 | $259.55 | $533.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.76 / $239.64 / $439.68
| Professional | | $170.76 | $239.64 | $439.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.19 / $276.30 / $491.21
| Professional | | $172.19 | $276.30 | $491.21 |