- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $436.52
| Professional | | $181.97 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $363.08
| Professional | | $165.96 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $407.38 / $549.54
| Professional | 50 | $251.19 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $257.04 / $436.52
| Professional | | $234.42 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $389.05
| Professional | | $208.93 | $257.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $575.44
| Professional | | $181.97 | $269.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $275.42 / $426.58
| Professional | | $194.98 | $275.42 | $426.58 |