- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.14 / $275.50 / $381.63
| Professional | | $185.14 | $275.50 | $381.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.69 / $386.94 / $1,162.44
| Professional | | $318.69 | $386.94 | $1,162.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.90 / $290.17 / $775.19
| Professional | | $195.90 | $290.17 | $775.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.03 / $393.47 / $775.19
| Professional | | $254.03 | $393.47 | $775.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.77 / $383.70 / $1,115.44
| Professional | | $287.77 | $383.70 | $1,115.44 |