- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.95 / $129.91 / $313.52
| Professional | | $85.95 | $129.91 | $313.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.39 / $211.13 / $335.83
| Professional | | $125.39 | $211.13 | $335.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.79 / $229.46 / $312.97
| Professional | | $181.79 | $229.46 | $312.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $202.19 / $293.42
| Professional | | $145.00 | $202.19 | $293.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.28 / $227.09 / $321.72
| Professional | | $161.28 | $227.09 | $321.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.31 / $236.55 / $339.36
| Professional | | $161.31 | $236.55 | $339.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.50 / $253.31 / $374.20
| Professional | | $173.50 | $253.31 | $374.20 |