- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.45 / $157.99 / $299.64
| Professional | | $77.45 | $157.99 | $299.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.95 / $137.00 / $276.79
| Professional | | $81.95 | $137.00 | $276.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.85 / $216.70 / $256.10
| Professional | | $94.85 | $216.70 | $256.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.27 / $187.68 / $347.66
| Professional | | $87.27 | $187.68 | $347.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.06 / $193.82 / $347.96
| Professional | | $91.06 | $193.82 | $347.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.89 / $223.28 / $311.03
| Professional | | $167.89 | $223.28 | $311.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $223.36 / $397.22
| Professional | | $156.44 | $223.36 | $397.22 |