- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.51 / $190.15 / $235.43
| Professional | | $168.51 | $190.15 | $235.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.73 / $149.10 / $211.72
| Professional | | $126.73 | $149.10 | $211.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.10 / $223.65 / $317.58
| Professional | 50 | $190.10 | $223.65 | $317.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.90 / $220.26 / $304.98
| Professional | | $177.90 | $220.26 | $304.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.09 / $229.27 / $402.38
| Professional | | $175.09 | $229.27 | $402.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.04 / $223.25 / $339.06
| Professional | | $180.04 | $223.25 | $339.06 |