- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $707.95
| Professional | | $194.98 | $281.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $1,819.70
| Professional | | $213.80 | $389.05 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $912.01
| Professional | | $257.04 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $173.78 / $416.87
| Professional | | $44.67 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $691.83
| Professional | | $251.19 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $1,819.70
| Professional | | $213.80 | $389.05 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $776.25
| Professional | | $251.19 | $389.05 | $776.25 |