- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.91 / $217.53 / $258.81
| Professional | | $209.91 | $217.53 | $258.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.10 / $262.10 / $598.08
| Professional | | $262.10 | $262.10 | $598.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.53 / $309.95 / $554.29
| Professional | | $194.53 | $309.95 | $554.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.56 / $509.80 / $509.80
| Professional | | $242.56 | $509.80 | $509.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.17 / $248.25 / $535.78
| Professional | | $182.17 | $248.25 | $535.78 |