- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.79 / $206.58 / $350.56
| Professional | | $119.79 | $206.58 | $350.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $228.68 / $344.42
| Professional | | $139.47 | $228.68 | $344.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $209.22 / $343.02 / $516.63
| Professional | 50 | $209.22 | $343.02 | $516.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.51 / $285.86 / $505.69
| Professional | | $153.51 | $285.86 | $505.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.58 / $255.46 / $434.86
| Professional | | $154.58 | $255.46 | $434.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.79 / $206.58 / $370.50
| Professional | | $119.79 | $206.58 | $370.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.98 / $301.01 / $463.18
| Professional | | $253.98 | $301.01 | $463.18 |