- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $331.13
| Professional | | $104.71 | $144.54 | $331.13 |
- 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
- $234.42 / $275.42 / $489.78
| Professional | | $234.42 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $229.09
| Professional | | $112.20 | $190.55 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $489.78
| Professional | | $223.87 | $223.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $478.63
| Professional | | $123.03 | $154.88 | $478.63 |