- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.51 / $179.41 / $215.59
| Professional | | $168.51 | $179.41 | $215.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.27 / $165.13 / $260.24
| Professional | | $136.27 | $165.13 | $260.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $204.40 / $247.69 / $390.36
| Professional | 50 | $204.40 | $247.69 | $390.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.17 / $234.04 / $334.34
| Professional | | $167.17 | $234.04 | $334.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.97 / $244.43 / $417.28
| Professional | | $174.97 | $244.43 | $417.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.65 / $249.00 / $353.59
| Professional | | $165.65 | $249.00 | $353.59 |