- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.20 / $164.71 / $323.98
| Professional | | $126.20 | $164.71 | $323.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.46 / $258.16 / $411.48
| Professional | | $161.46 | $258.16 | $411.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $242.19 / $387.24 / $617.22
| Professional | 50 | $242.19 | $387.24 | $617.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.44 / $315.06 / $610.74
| Professional | | $166.44 | $315.06 | $610.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.35 / $299.94 / $519.52
| Professional | | $167.35 | $299.94 | $519.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.95 / $164.71 / $323.98
| Professional | | $124.95 | $164.71 | $323.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.66 / $374.78 / $498.10
| Professional | | $325.66 | $374.78 | $498.10 |