- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.50 / $169.37 / $219.37
| Professional | | $144.50 | $169.37 | $219.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.21 / $235.47 / $295.44
| Professional | | $168.21 | $235.47 | $295.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.88 / $211.14 / $246.83
| Professional | | $203.88 | $211.14 | $246.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.26 / $99.26 / $140.47
| Professional | | $99.26 | $99.26 | $140.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.18 / $242.39 / $303.20
| Professional | | $193.18 | $242.39 | $303.20 |