- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.41 / $222.44 / $522.71
| Professional | | $183.41 | $222.44 | $522.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.13 / $262.50 / $473.72
| Professional | | $187.13 | $262.50 | $473.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $280.69 / $393.75 / $710.58
| Professional | 50 | $280.69 | $393.75 | $710.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.75 / $304.98 / $487.97
| Professional | | $203.75 | $304.98 | $487.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.96 / $236.55 / $307.51
| Professional | | $181.96 | $236.55 | $307.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.05 / $277.79 / $465.14
| Professional | | $194.05 | $277.79 | $465.14 |