- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.30 / $343.15 / $487.96
| Professional | | $221.30 | $343.15 | $487.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.35 / $416.58 / $494.26
| Professional | | $200.35 | $416.58 | $494.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $300.52 / $624.87 / $741.39
| Professional | 50 | $300.52 | $624.87 | $741.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.43 / $347.25 / $520.04
| Professional | | $232.43 | $347.25 | $520.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.62 / $311.27 / $311.27
| Professional | | $276.62 | $311.27 | $311.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.23 / $299.55 / $530.41
| Professional | | $192.23 | $299.55 | $530.41 |