- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.65 / $213.57 / $372.52
| Professional | | $114.65 | $213.57 | $372.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.98 / $184.98 / $298.79
| Professional | | $184.98 | $184.98 | $298.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.95 / $226.48 / $380.88
| Professional | | $124.95 | $226.48 | $380.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.09 / $321.79 / $1,632.40
| Professional | | $203.09 | $321.79 | $1,632.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.09 / $241.23 / $365.46
| Professional | | $198.09 | $241.23 | $365.46 |