- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.75 / $253.45 / $742.17
| Professional | | $128.75 | $253.45 | $742.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.60 / $241.33 / $426.66
| Professional | | $157.60 | $241.33 | $426.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.75 / $267.12 / $487.14
| Professional | | $209.75 | $267.12 | $487.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $346.07 / $435.38
| Professional | | $32.34 | $346.07 | $435.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.75 / $299.49 / $510.54
| Professional | | $244.75 | $299.49 | $510.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.80 / $303.79 / $475.88
| Professional | | $210.80 | $303.79 | $475.88 |