- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.55 / $234.77 / $234.77
| Professional | | $182.55 | $234.77 | $234.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.87 / $251.35 / $363.07
| Professional | | $224.87 | $251.35 | $363.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $337.30 / $377.02 / $544.60
| Professional | 50 | $337.30 | $377.02 | $544.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.91 / $288.64 / $430.92
| Professional | | $240.91 | $288.64 | $430.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.74 / $267.54 / $410.43
| Professional | | $207.74 | $267.54 | $410.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.55 / $234.77 / $234.77
| Professional | | $182.55 | $234.77 | $234.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.76 / $283.82 / $385.72
| Professional | | $212.76 | $283.82 | $385.72 |