- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $398.11
| Professional | | $158.49 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Professional | 50 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $446.68
| Professional | | $162.18 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $125.89 / $190.55
| Professional | | $117.49 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $234.42
| Professional | | $32.36 | $33.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $380.19
| Professional | | $151.36 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $165.96
| Professional | | $144.54 | $144.54 | $165.96 |