- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.49 / $227.05 / $758.35
| Professional | | $145.49 | $227.05 | $758.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.97 / $276.97 / $977.04
| Professional | | $276.97 | $276.97 | $977.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $314.63 / $977.04
| Professional | | $201.36 | $314.63 | $977.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.85 / $324.83 / $977.04
| Professional | | $214.85 | $324.83 | $977.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.25 / $351.22 / $1,199.21
| Professional | | $232.25 | $351.22 | $1,199.21 |