- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $229.25 / $374.02
| Professional | | $138.82 | $229.25 | $374.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.71 / $312.68 / $534.20
| Professional | | $164.71 | $312.68 | $534.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $166.99 / $337.29 / $540.48
| Professional | 50 | $166.99 | $337.29 | $540.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.01 / $277.18 / $471.14
| Professional | | $167.01 | $277.18 | $471.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.13 / $292.42 / $504.20
| Professional | | $174.13 | $292.42 | $504.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.39 / $407.40 / $672.18
| Professional | | $294.39 | $407.40 | $672.18 |