- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.64 / $220.61 / $429.68
| Professional | | $210.64 | $220.61 | $429.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.46 / $177.47 / $265.23
| Professional | | $150.46 | $177.47 | $265.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $225.69 / $265.51 / $390.52
| Professional | 50 | $225.69 | $265.51 | $390.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.71 / $316.36 / $548.69
| Professional | | $209.71 | $316.36 | $548.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.41 / $300.69 / $506.70
| Professional | | $169.41 | $300.69 | $506.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.64 / $210.64 / $416.22
| Professional | | $210.64 | $210.64 | $416.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.77 / $363.37 / $491.37
| Professional | | $254.77 | $363.37 | $491.37 |