- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $181.97 / $331.13
| Professional | | $102.33 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $239.88
| Professional | | $102.33 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $245.47 / $331.13
| Professional | 50 | $154.88 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $354.81
| Professional | | $138.04 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $363.08
| Professional | | $125.89 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $354.81
| Professional | | $97.72 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $363.08
| Professional | | $131.83 | $208.93 | $363.08 |