- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.27 / $211.56 / $505.98
| Professional | | $105.27 | $211.56 | $505.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.46 / $262.77 / $488.75
| Professional | | $161.46 | $262.77 | $488.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $242.19 / $394.16 / $754.02
| Professional | 50 | $242.19 | $394.16 | $754.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.87 / $382.07 / $758.08
| Professional | | $192.87 | $382.07 | $758.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.30 / $422.02 / $925.76
| Professional | | $171.30 | $422.02 | $925.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.70 / $441.97 / $891.23
| Professional | | $351.70 | $441.97 | $891.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.05 / $198.09 / $292.91
| Professional | | $115.05 | $198.09 | $292.91 |