- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $102.33 / $177.83
| Professional | | $61.66 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $97.72 / $177.83
| Professional | | $69.18 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $102.33 / $147.91 / $239.88
| Professional | 50 | $102.33 | $147.91 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $147.91 / $234.42
| Professional | | $87.10 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $112.20 / $194.98
| Professional | | $72.44 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $123.03 / $316.23
| Professional | | $64.57 | $123.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $138.04 / $257.04
| Professional | | $83.18 | $138.04 | $257.04 |