- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $281.84
| Professional | | $151.36 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $478.63
| Professional | | $323.59 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $489.78 / $602.56 / $724.44
| Professional | 50 | $489.78 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $588.84
| Professional | | $251.19 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $416.87
| Professional | | $190.55 | $338.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $478.63
| Professional | | $190.55 | $338.84 | $478.63 |