- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $478.63
| Professional | | $151.36 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | 50 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $478.63 / $1,023.29
| Professional | | $407.38 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $295.12 / $478.63
| Professional | | $218.78 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,023.29
| Professional | | $467.74 | $467.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $338.84 / $676.08
| Professional | | $165.96 | $338.84 | $676.08 |