- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.89 / $341.80 / $511.56
| Professional | | $234.89 | $341.80 | $511.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.95 / $409.50 / $613.60
| Professional | | $278.95 | $409.50 | $613.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $94.70 / $513.08
| Professional | | $32.34 | $94.70 | $513.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.44 / $481.36 / $764.48
| Professional | | $303.44 | $481.36 | $764.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.97 / $501.49 / $794.61
| Professional | | $362.97 | $501.49 | $794.61 |