- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.59 / $157.16 / $207.23
| Professional | | $115.59 | $157.16 | $207.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.87 / $141.03 / $206.01
| Professional | | $119.87 | $141.03 | $206.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $179.81 / $211.54 / $309.02
| Professional | 50 | $179.81 | $211.54 | $309.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.76 / $206.08 / $338.10
| Professional | | $133.76 | $206.08 | $338.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.38 / $199.50 / $354.09
| Professional | | $134.38 | $199.50 | $354.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.40 / $165.75 / $216.88
| Professional | | $118.40 | $165.75 | $216.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.80 / $239.38 / $326.60
| Professional | | $155.80 | $239.38 | $326.60 |