- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.70 / $224.12 / $301.10
| Professional | | $203.70 | $224.12 | $301.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.07 / $291.39 / $401.93
| Professional | | $222.07 | $291.39 | $401.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $233.43 / $258.30 / $374.06
| Professional | 50 | $233.43 | $258.30 | $374.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.75 / $293.22 / $376.28
| Professional | | $210.75 | $293.22 | $376.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.46 / $287.63 / $369.80
| Professional | | $233.46 | $287.63 | $369.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.72 / $301.83 / $583.55
| Professional | | $221.72 | $301.83 | $583.55 |