- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.25 / $212.93 / $273.08
| Professional | | $166.25 | $212.93 | $273.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $98.86 / $98.86 / $296.58
| Professional | 50 | $98.86 | $98.86 | $296.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.14 / $340.83 / $587.12
| Professional | | $289.14 | $340.83 | $587.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.94 / $250.42 / $361.86
| Professional | | $199.94 | $250.42 | $361.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.51 / $250.42 / $361.86
| Professional | | $145.51 | $250.42 | $361.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.45 / $293.52 / $659.04
| Professional | | $192.45 | $293.52 | $659.04 |