- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $112.20 / $275.42
| Professional | | $52.48 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $363.08
| Professional | | $131.83 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $194.98 / $537.03
| Professional | 50 | $109.65 | $194.98 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $302.00
| Professional | | $93.33 | $169.82 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $3,235.94
| Facility | | $588.84 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $177.83 / $371.54
| Professional | | $95.50 | $177.83 | $371.54 |