- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.95 / $202.77 / $477.57
| Professional | | $117.95 | $202.77 | $477.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.50 / $210.62 / $303.56
| Professional | | $134.50 | $210.62 | $303.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.37 / $279.73 / $477.78
| Professional | | $156.37 | $279.73 | $477.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.82 / $271.77 / $498.32
| Professional | | $146.82 | $271.77 | $498.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.30 / $249.08 / $487.28
| Professional | | $194.30 | $249.08 | $487.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.71 / $111.87 / $134.24
| Professional | | $90.71 | $111.87 | $134.24 |