- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.79 / $218.99 / $427.70
| Professional | | $120.79 | $218.99 | $427.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.15 / $315.95 / $548.87
| Professional | | $150.15 | $315.95 | $548.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.96 / $260.77 / $610.10
| Professional | | $175.96 | $260.77 | $610.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.79 / $392.23 / $509.05
| Professional | | $275.79 | $392.23 | $509.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.77 / $368.84 / $977.54
| Professional | | $210.77 | $368.84 | $977.54 |