- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.03 / $249.26 / $454.56
| Professional | | $138.03 | $249.26 | $454.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.32 / $202.74 / $301.37
| Professional | | $172.32 | $202.74 | $301.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $258.49 / $304.11 / $446.63
| Professional | 50 | $258.49 | $304.11 | $446.63 |
- 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
- $241.33 / $337.96 / $569.91
| Professional | | $241.33 | $337.96 | $569.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.50 / $337.18 / $524.65
| Professional | | $192.50 | $337.18 | $524.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.35 / $251.21 / $454.56
| Professional | | $149.35 | $251.21 | $454.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.61 / $376.43 / $486.77
| Professional | | $259.61 | $376.43 | $486.77 |