- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.28 / $226.76 / $299.60
| Professional | | $128.28 | $226.76 | $299.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.13 / $185.09 / $324.23
| Professional | | $122.13 | $185.09 | $324.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $183.20 / $277.64 / $486.34
| Professional | 50 | $183.20 | $277.64 | $486.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.80 / $198.72 / $468.89
| Professional | | $147.80 | $198.72 | $468.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.54 / $259.24 / $494.19
| Professional | | $143.54 | $259.24 | $494.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.88 / $327.86 / $512.89
| Professional | | $220.88 | $327.86 | $512.89 |