- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.38 / $230.42 / $250.35
| Professional | | $130.38 | $230.42 | $250.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.33 / $193.25 / $244.06
| Professional | | $149.33 | $193.25 | $244.06 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $224.00 / $289.88 / $360.75
| Professional | 50 | $224.00 | $289.88 | $360.75 |
- 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
- $193.89 / $288.29 / $320.20
| Professional | | $193.89 | $288.29 | $320.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.67 / $213.66 / $327.77
| Professional | | $184.67 | $213.66 | $327.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $146.22 / $242.51
| Professional | | $122.56 | $146.22 | $242.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.44 / $217.17 / $280.82
| Professional | | $151.44 | $217.17 | $280.82 |