- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $794.33
| Professional | | $208.93 | $323.59 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $758.58
| Professional | | $489.78 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $512.86 / $851.14
| Professional | | $190.55 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $524.81 / $575.44
| Professional | | $229.09 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $724.44
| Professional | | $229.09 | $416.87 | $724.44 |