- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $436.52
| Professional | | $151.36 | $213.80 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | 50 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $181.97 / $213.80
| Professional | | $112.20 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $169.82 / $275.42 / $323.59
| Professional | 50 | $169.82 | $275.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $251.19 / $331.13
| Professional | | $194.98 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $302.00
| Professional | | $138.04 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $436.52
| Professional | | $151.36 | $213.80 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | 50 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $346.74
| Professional | | $138.04 | $213.80 | $346.74 |