- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.84 / $295.64 / $385.44
| Professional | | $187.84 | $295.64 | $385.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.07 / $404.82 / $559.34
| Professional | | $244.07 | $404.82 | $559.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.33 / $433.71 / $865.06
| Professional | | $292.33 | $433.71 | $865.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.66 / $357.95 / $505.31
| Professional | | $296.66 | $357.95 | $505.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.06 / $378.83 / $776.16
| Professional | | $237.06 | $378.83 | $776.16 |