- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.99 / $113.99 / $140.72
| Professional | | $113.99 | $113.99 | $140.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.29 / $84.43 / $119.62
| Professional | | $56.29 | $84.43 | $119.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.98 / $142.40 / $296.80
| Professional | | $98.98 | $142.40 | $296.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.72 / $168.88 / $305.50
| Professional | | $140.72 | $168.88 | $305.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $140.72 / $173.09
| Professional | | $19.10 | $140.72 | $173.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $140.72 / $342.09
| Professional | | $84.44 | $140.72 | $342.09 |