- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.98 / $116.85 / $246.20
| Professional | | $69.98 | $116.85 | $246.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $152.77 / $226.57
| Professional | | $95.90 | $152.77 | $226.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.01 / $170.29 / $289.89
| Professional | | $96.01 | $170.29 | $289.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $183.84 / $309.51
| Professional | | $109.65 | $183.84 | $309.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.98 / $121.93 / $257.70
| Professional | | $69.98 | $121.93 | $257.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.61 / $196.11 / $303.74
| Professional | | $138.61 | $196.11 | $303.74 |