- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.03 / $82.40 / $121.38
| Professional | | $57.03 | $82.40 | $121.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.28 / $82.68 / $120.17
| Professional | | $70.28 | $82.68 | $120.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $105.42 / $124.03 / $180.25
| Professional | 50 | $105.42 | $124.03 | $180.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.08 / $121.24 / $175.85
| Professional | | $76.08 | $121.24 | $175.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.55 / $113.36 / $201.20
| Professional | | $79.55 | $113.36 | $201.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.89 / $95.32 / $127.03
| Professional | | $71.89 | $95.32 | $127.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.55 / $113.60 / $180.60
| Professional | | $79.55 | $113.60 | $180.60 |