- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $426.58
| Professional | | $177.83 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $380.19
| Professional | | $169.82 | $275.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $416.87 / $562.34
| Professional | 50 | $251.19 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $302.00 / $501.19
| Professional | | $204.17 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $288.40
| Professional | | $169.82 | $204.17 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $457.09
| Professional | | $186.21 | $251.19 | $457.09 |