- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.95 / $318.62 / $416.87
| Professional | | $220.95 | $318.62 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.50 / $631.02 / $859.86
| Professional | | $467.50 | $631.02 | $859.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.43 / $587.35 / $967.50
| Professional | | $300.43 | $587.35 | $967.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.16 / $708.43 / $2,529.28
| Professional | | $353.16 | $708.43 | $2,529.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.98 / $633.69 / $912.92
| Professional | | $304.98 | $633.69 | $912.92 |