- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $144.54 / $331.13
| Professional | | $109.65 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $630.96
| Professional | | $371.54 | $588.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $562.34 / $954.99
| Professional | 50 | $346.74 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $169.82 / $245.47
| Professional | | $128.82 | $169.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $295.12 / $3,090.30
| Facility | | $257.04 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $229.09 / $407.38
| Professional | | $123.03 | $229.09 | $407.38 |