- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $67.61 / $141.25
| Professional | | $38.02 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $125.89 / $194.98 / $416.87
| Professional | 50 | $125.89 | $194.98 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $112.20 / $165.96
| Professional | | $72.44 | $112.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $87.10 / $162.18
| Professional | | $54.95 | $87.10 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $295.12 / $3,090.30
| Facility | | $251.19 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $89.13 / $190.55
| Professional | | $50.12 | $89.13 | $190.55 |