- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.69 / $121.80 / $352.67
| Professional | | $78.69 | $121.80 | $352.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.03 / $185.78 / $260.48
| Professional | | $103.03 | $185.78 | $260.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.71 / $269.44 / $442.91
| Professional | | $149.71 | $269.44 | $442.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.47 / $265.51 / $518.90
| Professional | | $132.47 | $265.51 | $518.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.47 / $295.93 / $507.90
| Professional | | $195.47 | $295.93 | $507.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.28 / $109.59 / $143.33
| Professional | | $78.28 | $109.59 | $143.33 |