- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $229.25 / $342.30
| Professional | | $138.82 | $229.25 | $342.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.19 / $269.94 / $415.29
| Professional | | $145.19 | $269.94 | $415.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $343.07 / $403.62 / $448.47
| Professional | 50 | $343.07 | $403.62 | $448.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.28 / $228.69 / $412.08
| Professional | | $126.28 | $228.69 | $412.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.21 / $234.00 / $428.29
| Professional | | $108.21 | $234.00 | $428.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.60 / $129.81 / $336.48
| Professional | | $115.60 | $129.81 | $336.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $303.17 / $462.38
| Professional | | $230.15 | $303.17 | $462.38 |