- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.58 / $235.58 / $235.58
| Professional | | $235.58 | $235.58 | $235.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.36 / $260.89 / $361.20
| Professional | | $214.36 | $260.89 | $361.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $134.39 / $202.90
| Professional | | $32.99 | $134.39 | $202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.64 / $375.87 / $399.55
| Professional | | $272.64 | $375.87 | $399.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.02 / $188.91 / $328.10
| Professional | | $169.02 | $188.91 | $328.10 |