- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.34 / $123.34 / $349.42
| Professional | | $78.34 | $123.34 | $349.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.99 / $213.19 / $367.94
| Professional | | $123.99 | $213.19 | $367.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.85 / $296.37 / $343.36
| Professional | | $247.85 | $296.37 | $343.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.35 / $215.62 / $324.08
| Professional | | $163.35 | $215.62 | $324.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.24 / $243.04 / $351.86
| Professional | | $141.24 | $243.04 | $351.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $225.69 / $360.28
| Professional | | $153.00 | $225.69 | $360.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.87 / $211.86 / $346.17
| Professional | | $150.87 | $211.86 | $346.17 |