- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $95.50 / $162.18
| Professional | | $52.48 | $95.50 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $316.23
| Professional | | $131.83 | $208.93 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $263.03 / $478.63
| Professional | 50 | $109.65 | $263.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $165.96 / $316.23
| Professional | | $91.20 | $165.96 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $794.33 / $3,235.94
| Facility | | $758.58 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $389.05
| Professional | | $91.20 | $158.49 | $389.05 |