- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.35 / $172.53 / $233.45
| Professional | | $102.35 | $172.53 | $233.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $260.91 / $260.91 / $260.91
| Professional | 50 | $260.91 | $260.91 | $260.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.12 / $120.48 / $137.71
| Professional | | $92.12 | $120.48 | $137.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.90 / $130.90 / $130.90
| Facility | | $130.90 | $130.90 | $130.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.61 / $200.28 / $379.79
| Professional | | $112.61 | $200.28 | $379.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.93 / $248.29 / $433.73
| Professional | | $183.93 | $248.29 | $433.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.15 / $211.42 / $369.07
| Professional | | $153.15 | $211.42 | $369.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $221.34 / $273.02
| Professional | | $146.84 | $221.34 | $273.02 |