- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.20 / $229.25 / $284.32
| Professional | | $126.20 | $229.25 | $284.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.81 / $259.72 / $436.42
| Professional | | $146.81 | $259.72 | $436.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $220.21 / $389.58 / $654.63
| Professional | 50 | $220.21 | $389.58 | $654.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.83 / $280.43 / $555.11
| Professional | | $139.83 | $280.43 | $555.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.91 / $499.30 / $2,033.68
| Professional | | $274.91 | $499.30 | $2,033.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.61 / $366.37 / $574.48
| Professional | | $262.61 | $366.37 | $574.48 |