- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.79 / $213.60 / $325.64
| Professional | | $149.79 | $213.60 | $325.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.07 / $152.07 / $152.07
| Professional | | $152.07 | $152.07 | $152.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.73 / $289.26 / $330.58
| Professional | | $272.73 | $289.26 | $330.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $292.08
| Professional | | $30.00 | $30.00 | $292.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.70 / $261.85 / $277.93
| Professional | | $259.70 | $261.85 | $277.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.10 / $254.86 / $414.02
| Professional | | $207.10 | $254.86 | $414.02 |