- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.95 / $221.11 / $286.31
| Professional | | $77.95 | $221.11 | $286.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.96 / $237.64 / $476.84
| Professional | | $89.96 | $237.64 | $476.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.68 / $212.87 / $374.42
| Professional | | $198.68 | $212.87 | $374.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.90 / $334.69 / $445.84
| Professional | | $235.90 | $334.69 | $445.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.26 / $336.41 / $583.55
| Professional | | $233.26 | $336.41 | $583.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.92 / $232.09 / $232.09
| Professional | | $67.92 | $232.09 | $232.09 |