- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.68 / $186.32 / $205.63
| Professional | | $106.68 | $186.32 | $205.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $156.22 / $197.30
| Professional | | $120.72 | $156.22 | $197.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $181.08 / $234.34 / $295.08
| Professional | 50 | $181.08 | $234.34 | $295.08 |
- 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
- $166.01 / $235.86 / $269.17
| Professional | | $166.01 | $235.86 | $269.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.87 / $174.56 / $267.77
| Professional | | $150.87 | $174.56 | $267.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.68 / $146.93 / $218.83
| Professional | | $106.68 | $146.93 | $218.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.47 / $177.65 / $237.55
| Professional | | $127.47 | $177.65 | $237.55 |