- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.70 / $130.69 / $318.92
| Professional | | $100.70 | $130.69 | $318.92 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $156.26 / $195.48 / $931.50
| Professional | 50 | $156.26 | $195.48 | $931.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.26 / $278.49 / $485.35
| Professional | | $236.26 | $278.49 | $485.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.12 / $193.96 / $234.37
| Professional | | $112.12 | $193.96 | $234.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.56 / $190.12 / $229.09
| Professional | | $106.56 | $190.12 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $164.13 / $540.65
| Professional | | $143.91 | $164.13 | $540.65 |