- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.99 / $190.99 / $206.68
| Professional | | $190.99 | $190.99 | $206.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.93 / $402.32 / $475.80
| Professional | | $360.93 | $402.32 | $475.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $541.40 / $600.91 / $709.98
| Professional | 50 | $541.40 | $600.91 | $709.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.94 / $454.18 / $586.51
| Professional | | $235.94 | $454.18 | $586.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.52 / $356.89 / $499.24
| Professional | | $194.52 | $356.89 | $499.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.07 / $380.12 / $499.24
| Professional | | $228.07 | $380.12 | $499.24 |