- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.25 / $207.34 / $273.17
| Professional | | $166.25 | $207.34 | $273.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.88 / $164.36 / $213.70
| Professional | | $136.88 | $164.36 | $213.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $205.34 / $246.54 / $320.55
| Professional | 50 | $205.34 | $246.54 | $320.55 |
- 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
- $195.39 / $252.19 / $321.85
| Professional | | $195.39 | $252.19 | $321.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.87 / $197.03 / $306.58
| Professional | | $157.87 | $197.03 | $306.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.46 / $207.34 / $301.04
| Professional | | $155.46 | $207.34 | $301.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $258.36 / $327.07
| Professional | | $161.62 | $258.36 | $327.07 |