- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $158.49 / $630.96
| Professional | | $60.26 | $158.49 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $83.18 / $323.59 / $1,148.15
| Professional | 50 | $83.18 | $323.59 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,162.28
| Facility | | $3,019.95 | $3,019.95 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $165.96 / $346.74
| Professional | | $69.18 | $165.96 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $407.38
| Professional | | $177.83 | $251.19 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $234.42 / $416.87
| Professional | | $81.28 | $234.42 | $416.87 |