- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $123.03 / $154.88
| Professional | | $97.72 | $123.03 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | 50 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $165.96 / $354.81
| Professional | | $141.25 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $141.25 / $194.98
| Professional | | $97.72 | $141.25 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $354.81
| Professional | | $162.18 | $162.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $316.23
| Professional | | $85.11 | $128.82 | $316.23 |