- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.56 / $197.51 / $269.95
| Professional | | $115.56 | $197.51 | $269.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.39 / $375.97 / $574.95
| Professional | | $235.39 | $375.97 | $574.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.38 / $306.39 / $612.36
| Professional | | $157.38 | $306.39 | $612.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.26 / $423.19 / $1,692.80
| Professional | | $218.26 | $423.19 | $1,692.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.13 / $406.73 / $582.00
| Professional | | $202.13 | $406.73 | $582.00 |