- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $181.97 / $281.84
| Professional | | $107.15 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $501.19
| Professional | | $245.47 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $204.17 / $363.08 / $741.31
| Professional | 50 | $204.17 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $213.80 / $371.54
| Professional | | $131.83 | $213.80 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $295.12 / $3,090.30
| Facility | | $199.53 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $309.03 / $562.34
| Professional | | $147.91 | $309.03 | $562.34 |