- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.65 / $149.04 / $254.73
| Professional | | $79.65 | $149.04 | $254.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.40 / $118.11 / $186.11
| Professional | | $100.40 | $118.11 | $186.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.61 / $207.03 / $433.29
| Professional | | $115.61 | $207.03 | $433.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.06 / $275.76 / $442.71
| Professional | | $117.06 | $275.76 | $442.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.17 / $149.04 / $263.47
| Professional | | $91.17 | $149.04 | $263.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.68 / $266.44 / $434.99
| Professional | | $193.68 | $266.44 | $434.99 |