- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $602.56
| Professional | | $190.55 | $295.12 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $602.56
| Professional | | $234.42 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $831.76
| Professional | | $281.84 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $489.78 / $776.25
| Professional | | $275.42 | $489.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $389.05 / $1,148.15
| Professional | | $204.17 | $389.05 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $758.58
| Professional | | $275.42 | $398.11 | $758.58 |