- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.94 / $305.63 / $654.85
| Professional | | $143.94 | $305.63 | $654.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.49 / $354.65 / $686.20
| Professional | | $198.49 | $354.65 | $686.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.86 / $375.09 / $764.94
| Professional | | $193.86 | $375.09 | $764.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.76 / $414.14 / $820.28
| Professional | | $214.76 | $414.14 | $820.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.94 / $305.63 / $539.79
| Professional | | $143.94 | $305.63 | $539.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.57 / $509.24 / $806.86
| Professional | | $361.57 | $509.24 | $806.86 |