- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.88 / $278.85 / $509.20
| Professional | | $133.88 | $278.85 | $509.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.37 / $289.27 / $530.80
| Professional | | $169.37 | $289.27 | $530.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $254.05 / $433.90 / $796.21
| Professional | 50 | $254.05 | $433.90 | $796.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.93 / $334.76 / $617.52
| Professional | | $177.93 | $334.76 | $617.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $288.97 / $658.11
| Professional | | $145.66 | $288.97 | $658.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.06 / $244.98 / $431.48
| Professional | | $168.06 | $244.98 | $431.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.55 / $367.98 / $639.27
| Professional | | $256.55 | $367.98 | $639.27 |