- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $91.20 / $173.78
| Professional | | $64.57 | $91.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $363.08 / $389.05
| Professional | | $223.87 | $363.08 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $204.17 / $331.13 / $588.84
| Professional | 50 | $204.17 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $151.36
| Professional | | $81.28 | $104.71 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,288.25 / $5,370.32
| Facility | | $831.76 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $144.54 / $263.03
| Professional | | $81.28 | $144.54 | $263.03 |