- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $234.42 / $602.56
| Professional | | $48.98 | $234.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $954.99
| Professional | | $457.09 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $138.04 / $812.83
| Professional | | $70.79 | $138.04 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $954.99
| Professional | | $457.09 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $302.00 / $776.25
| Professional | | $63.10 | $302.00 | $776.25 |