- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.20 / $238.55 / $374.02
| Professional | | $126.20 | $238.55 | $374.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $472.61 / $472.61 / $472.61
| Professional | 50 | $472.61 | $472.61 | $472.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.68 / $266.35 / $459.80
| Professional | | $157.68 | $266.35 | $459.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $231.20 / $391.87 / $628.30
| Professional | 50 | $231.20 | $391.87 | $628.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.69 / $280.88 / $537.64
| Professional | | $153.69 | $280.88 | $537.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.99 / $356.04 / $591.28
| Professional | | $251.99 | $356.04 | $591.28 |