- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.90 / $173.00 / $264.48
| Professional | | $111.90 | $173.00 | $264.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.10 / $220.90 / $306.83
| Professional | | $146.10 | $220.90 | $306.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $219.15 / $331.35 / $460.24
| Professional | 50 | $219.15 | $331.35 | $460.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.69 / $257.68 / $447.86
| Professional | | $164.69 | $257.68 | $447.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.12 / $248.97 / $387.40
| Professional | | $166.12 | $248.97 | $387.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.43 / $192.38 / $316.60
| Professional | | $126.43 | $192.38 | $316.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.20 / $280.29 / $413.04
| Professional | | $192.20 | $280.29 | $413.04 |