- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.40 / $164.93 / $253.49
| Professional | | $72.40 | $164.93 | $253.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.32 / $105.09 / $167.12
| Professional | | $89.32 | $105.09 | $167.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $133.99 / $157.63 / $250.68
| Professional | 50 | $133.99 | $157.63 | $250.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.17 / $185.40 / $438.75
| Professional | | $99.17 | $185.40 | $438.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.11 / $278.64 / $447.34
| Professional | | $105.11 | $278.64 | $447.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.40 / $158.82 / $378.49
| Professional | | $72.40 | $158.82 | $378.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.70 / $256.62 / $465.95
| Professional | | $182.70 | $256.62 | $465.95 |