- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $575.44
| Professional | | $165.96 | $223.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $371.54 / $478.63
| Professional | | $190.55 | $371.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $562.34 / $724.44
| Professional | 50 | $288.40 | $562.34 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $478.63
| Professional | | $234.42 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $331.13
| Professional | | $323.59 | $323.59 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $263.03 / $478.63
| Professional | | $177.83 | $263.03 | $478.63 |