- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.56 / $205.32 / $301.20
| Professional | | $114.56 | $205.32 | $301.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.54 / $168.87 / $256.89
| Professional | | $143.54 | $168.87 | $256.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $215.31 / $253.30 / $385.33
| Professional | 50 | $215.31 | $253.30 | $385.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.83 / $282.94 / $563.40
| Professional | | $157.83 | $282.94 | $563.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.58 / $326.45 / $524.10
| Professional | | $161.58 | $326.45 | $524.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.56 / $237.65 / $349.87
| Professional | | $114.56 | $237.65 | $349.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.62 / $327.14 / $541.46
| Professional | | $225.62 | $327.14 | $541.46 |