- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.37 / $119.62 / $182.07
| Professional | | $89.37 | $119.62 | $182.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.58 / $130.40 / $167.66
| Professional | | $102.58 | $130.40 | $167.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $153.87 / $195.61 / $243.19
| Professional | 50 | $153.87 | $195.61 | $243.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.13 / $193.91 / $235.34
| Professional | | $142.13 | $193.91 | $235.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.48 / $144.02 / $220.94
| Professional | | $124.48 | $144.02 | $220.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.37 / $122.08 / $178.07
| Professional | | $89.37 | $122.08 | $178.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.51 / $158.76 / $211.40
| Professional | | $111.51 | $158.76 | $211.40 |