- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.95 / $281.62 / $448.07
| Professional | | $181.95 | $281.62 | $448.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.16 / $250.78 / $372.93
| Professional | | $213.16 | $250.78 | $372.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.54 / $302.27 / $445.97
| Professional | | $209.54 | $302.27 | $445.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.19 / $341.23 / $2,148.96
| Professional | | $267.19 | $341.23 | $2,148.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.67 / $308.58 / $452.40
| Professional | | $262.67 | $308.58 | $452.40 |