- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $199.53 / $346.74
| Professional | | $79.43 | $199.53 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $128.82 / $199.53
| Professional | | $77.62 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.82 / $194.98 / $275.42
| Professional | 50 | $114.82 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $199.53 / $436.52
| Professional | | $93.33 | $199.53 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $275.42 / $478.63
| Professional | | $95.50 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $190.55 / $446.68
| Professional | | $83.18 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | 50 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $181.97 / $436.52
| Professional | | $81.28 | $181.97 | $436.52 |