- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.47 / $304.69 / $603.71
| Professional | | $162.47 | $304.69 | $603.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.97 / $314.26 / $629.44
| Professional | | $182.97 | $314.26 | $629.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $267.23 / $471.40 / $918.69
| Professional | 50 | $267.23 | $471.40 | $918.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.57 / $356.38 / $667.61
| Professional | | $213.57 | $356.38 | $667.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.67 / $451.51 / $451.51
| Professional | | $369.67 | $451.51 | $451.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.87 / $420.05 / $710.89
| Professional | | $268.87 | $420.05 | $710.89 |