- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $112.20 / $223.87
| Professional | | $61.66 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $83.18 / $128.82
| Professional | | $48.98 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $125.89 / $194.98
| Professional | 50 | $72.44 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $123.03 / $229.09
| Professional | | $67.61 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $117.49 / $199.53
| Professional | | $60.26 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $125.89 / $257.04
| Professional | | $64.57 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $112.20 / $199.53
| Professional | | $60.26 | $112.20 | $199.53 |