- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $134.90 / $234.42
| Professional | | $89.13 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $154.88
| Professional | | $70.79 | $125.89 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $107.15 / $190.55 / $229.09
| Professional | 50 | $107.15 | $190.55 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $181.97 / $257.04
| Professional | | $134.90 | $181.97 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $144.54 / $229.09
| Professional | | $87.10 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $338.84
| Professional | | $102.33 | $138.04 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $147.91 / $239.88
| Professional | | $91.20 | $147.91 | $239.88 |