- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $794.33
| Professional | | $199.53 | $275.42 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $426.58 / $870.96
| Professional | | $354.81 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $426.58
| Professional | | $208.93 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $870.96
| Professional | | $398.11 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $295.12 / $891.25
| Professional | | $239.88 | $295.12 | $891.25 |