- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.88 / $234.18 / $767.20
| Professional | | $205.88 | $234.18 | $767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.43 / $362.36 / $1,543.86
| Professional | | $117.43 | $362.36 | $1,543.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.89 / $474.62 / $617.67
| Professional | | $283.89 | $474.62 | $617.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.09 / $199.09 / $316.82
| Professional | | $199.09 | $199.09 | $316.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.27 / $332.67 / $524.49
| Professional | | $263.27 | $332.67 | $524.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.43 / $362.36 / $1,543.86
| Professional | | $117.43 | $362.36 | $1,543.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.80 / $312.83 / $719.99
| Professional | | $119.80 | $312.83 | $719.99 |