- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $63.10 / $120.23
| Professional | | $45.71 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $295.12 / $295.12
| Professional | 50 | $138.04 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $70.79 / $151.36
| Professional | | $48.98 | $70.79 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $102.33 / $223.87
| Professional | 50 | $72.44 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $81.28 / $194.98
| Professional | | $46.77 | $81.28 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $64.57 / $123.03
| Professional | | $44.67 | $64.57 | $123.03 |