- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $108.80 / $154.85
| Professional | | $67.15 | $108.80 | $154.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.52 / $89.38 / $112.91
| Professional | | $73.52 | $89.38 | $112.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $110.28 / $134.07 / $168.28
| Professional | 50 | $110.28 | $134.07 | $168.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.02 / $133.49 / $165.45
| Professional | | $101.02 | $133.49 | $165.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.33 / $102.00 / $157.13
| Professional | | $85.33 | $102.00 | $157.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $107.23 / $154.34
| Professional | | $67.15 | $107.23 | $154.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.79 / $110.29 / $142.61
| Professional | | $78.79 | $110.29 | $142.61 |