- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.36 / $308.14 / $767.48
| Professional | | $219.36 | $308.14 | $767.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.24 / $285.93 / $408.07
| Professional | | $228.24 | $285.93 | $408.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $342.36 / $428.90 / $612.10
| Professional | 50 | $342.36 | $428.90 | $612.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.18 / $595.35 / $1,066.71
| Professional | | $243.18 | $595.35 | $1,066.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.20 / $560.94 / $1,021.33
| Professional | | $243.20 | $560.94 | $1,021.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.86 / $308.14 / $767.48
| Professional | | $205.86 | $308.14 | $767.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.63 / $683.75 / $1,091.15
| Professional | | $401.63 | $683.75 | $1,091.15 |