- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.90 / $292.12 / $417.75
| Professional | | $229.90 | $292.12 | $417.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.27 / $421.63 / $1,292.04
| Professional | | $347.27 | $421.63 | $1,292.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.14 / $342.60 / $815.55
| Professional | | $245.14 | $342.60 | $815.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.63 / $414.11 / $815.55
| Professional | | $300.63 | $414.11 | $815.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.63 / $400.83 / $1,165.25
| Professional | | $300.63 | $400.83 | $1,165.25 |