- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $97.72 / $436.52
| Professional | | $61.66 | $97.72 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $15.14 / $15.14 / $15.14
| Professional | 50 | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $245.47
| Professional | | $75.86 | $162.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $102.33 / $208.93
| Professional | | $66.07 | $102.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $117.49 / $147.91
| Professional | | $87.10 | $117.49 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $169.82 / $331.13
| Professional | | $162.18 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $87.10 / $154.88
| Professional | | $64.57 | $87.10 | $154.88 |