- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.95 / $87.94 / $99.28
| Professional | | $66.95 | $87.94 | $99.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.83 / $316.08 / $518.75
| Facility | | $228.83 | $316.08 | $518.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.08 / $113.08 / $157.09
| Professional | | $113.08 | $113.08 | $157.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.14 / $136.38 / $193.57
| Professional | | $98.14 | $136.38 | $193.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.92 / $122.02 / $220.12
| Professional | | $62.92 | $122.02 | $220.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.72 / $87.94 / $99.28
| Professional | | $63.72 | $87.94 | $99.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.08 / $212.18 / $381.45
| Professional | | $149.08 | $212.18 | $381.45 |