- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.56 / $212.40 / $364.23
| Professional | | $114.56 | $212.40 | $364.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.95 / $111.68 / $188.84
| Professional | | $79.95 | $111.68 | $188.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.21 / $211.52 / $320.45
| Professional | | $106.21 | $211.52 | $320.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $243.21 / $1,494.45
| Professional | | $208.25 | $243.21 | $1,494.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.50 / $235.84 / $310.05
| Professional | | $201.50 | $235.84 | $310.05 |