- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.94 / $182.55 / $715.23
| Professional | | $153.94 | $182.55 | $715.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.87 / $338.50 / $492.72
| Professional | | $224.87 | $338.50 | $492.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $337.30 / $507.75 / $739.09
| Professional | 50 | $337.30 | $507.75 | $739.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.21 / $408.91 / $578.94
| Professional | | $249.21 | $408.91 | $578.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.74 / $412.11 / $684.32
| Professional | | $207.74 | $412.11 | $684.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.04 / $373.72 / $739.12
| Professional | | $231.04 | $373.72 | $739.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.55 / $165.61 / $210.77
| Professional | | $150.55 | $165.61 | $210.77 |