- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.45 / $97.15 / $141.88
| Professional | | $65.45 | $97.15 | $141.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.51 / $73.54 / $106.82
| Professional | | $62.51 | $73.54 | $106.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $93.77 / $110.31 / $160.22
| Professional | 50 | $93.77 | $110.31 | $160.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.34 / $125.30 / $237.43
| Professional | | $68.34 | $125.30 | $237.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.19 / $135.19 / $217.05
| Professional | | $67.19 | $135.19 | $217.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.45 / $101.04 / $172.95
| Professional | | $65.45 | $101.04 | $172.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $177.72 / $224.93
| Professional | | $107.02 | $177.72 | $224.93 |