- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.04 / $86.65 / $106.29
| Professional | | $71.04 | $86.65 | $106.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.81 / $88.03 / $127.81
| Professional | | $74.81 | $88.03 | $127.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.24 / $132.04 / $191.71
| Professional | 50 | $112.24 | $132.04 | $191.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.10 / $118.56 / $185.03
| Professional | | $83.10 | $118.56 | $185.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.09 / $113.36 / $201.20
| Professional | | $84.09 | $113.36 | $201.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.44 / $89.27 / $124.05
| Professional | | $71.44 | $89.27 | $124.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.20 / $115.77 / $184.19
| Professional | | $79.20 | $115.77 | $184.19 |