- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.77 / $231.27 / $339.98
| Professional | | $150.77 | $231.27 | $339.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.14 / $281.14 / $434.85
| Professional | | $178.14 | $281.14 | $434.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $267.20 / $421.71 / $652.27
| Professional | 50 | $267.20 | $421.71 | $652.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $336.68 / $550.75
| Professional | | $182.45 | $336.68 | $550.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.25 / $316.98 / $549.02
| Professional | | $184.25 | $316.98 | $549.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.77 / $231.27 / $339.98
| Professional | | $150.77 | $231.27 | $339.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.70 / $376.76 / $583.99
| Professional | | $274.70 | $376.76 | $583.99 |