- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.35 / $80.28 / $102.47
| Professional | | $59.35 | $80.28 | $102.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.11 / $72.18 / $103.64
| Professional | | $61.11 | $72.18 | $103.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $91.66 / $108.27 / $155.47
| Professional | 50 | $91.66 | $108.27 | $155.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.39 / $105.39 / $162.66
| Professional | | $70.39 | $105.39 | $162.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.01 / $96.45 / $171.19
| Professional | | $68.01 | $96.45 | $171.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.93 / $87.42 / $127.21
| Professional | | $61.93 | $87.42 | $127.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.88 / $105.31 / $141.04
| Professional | | $72.88 | $105.31 | $141.04 |