- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.54 / $120.97 / $181.68
| Professional | | $90.54 | $120.97 | $181.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $33.86 / $177.03 / $209.63
| Professional | 50 | $33.86 | $177.03 | $209.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.57 / $458.57 / $495.42
| Facility | | $458.57 | $458.57 | $495.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.29 / $375.02 / $409.31
| Professional | | $258.29 | $375.02 | $409.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $167.99 / $329.25
| Professional | | $137.84 | $167.99 | $329.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.63 / $167.99 / $329.25
| Professional | | $104.63 | $167.99 | $329.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.68 / $256.94 / $414.89
| Professional | | $136.68 | $256.94 | $414.89 |