- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.70 / $299.33 / $503.80
| Professional | | $183.70 | $299.33 | $503.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.45 / $365.83 / $589.83
| Professional | | $246.45 | $365.83 | $589.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.98 / $190.44 / $304.57
| Professional | | $28.98 | $190.44 | $304.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.68 / $373.06 / $648.46
| Professional | | $234.68 | $373.06 | $648.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.54 / $395.64 / $624.99
| Professional | | $336.54 | $395.64 | $624.99 |