- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.48 / $249.80 / $493.49
| Professional | | $181.48 | $249.80 | $493.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.15 / $278.16 / $452.12
| Professional | | $143.15 | $278.16 | $452.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.22 / $409.37 / $669.89
| Professional | | $192.22 | $409.37 | $669.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.75 / $291.92 / $484.26
| Professional | | $147.75 | $291.92 | $484.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.99 / $240.55 / $493.49
| Professional | | $164.99 | $240.55 | $493.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.91 / $424.66 / $547.65
| Professional | | $310.91 | $424.66 | $547.65 |