- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.78 / $142.96 / $236.41
| Professional | | $103.78 | $142.96 | $236.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $239.28 / $366.25 / $1,160.29
| Professional | 50 | $239.28 | $366.25 | $1,160.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.81 / $266.17 / $534.84
| Professional | | $225.81 | $266.17 | $534.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.59 / $203.67 / $254.34
| Professional | | $131.59 | $203.67 | $254.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.72 / $203.59 / $254.34
| Professional | | $106.72 | $203.59 | $254.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $202.31 / $614.54
| Professional | | $153.13 | $202.31 | $614.54 |