- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.60 / $224.44 / $439.94
| Professional | | $135.60 | $224.44 | $439.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.43 / $502.09 / $922.06
| Professional | | $281.43 | $502.09 | $922.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.06 / $571.73 / $1,110.77
| Professional | | $285.06 | $571.73 | $1,110.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.55 / $530.63 / $982.84
| Professional | | $305.55 | $530.63 | $982.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.89 / $629.71 / $1,943.92
| Professional | | $277.89 | $629.71 | $1,943.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.65 / $545.17 / $990.74
| Professional | | $255.65 | $545.17 | $990.74 |