- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.41 / $131.94 / $431.47
| Professional | | $58.41 | $131.94 | $431.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $647.20 / $647.20 / $647.20
| Professional | 50 | $647.20 | $647.20 | $647.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.49 / $297.49 / $359.70
| Facility | | $297.49 | $297.49 | $359.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.88 / $184.92 / $292.61
| Professional | | $156.88 | $184.92 | $292.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.96 / $113.77 / $292.61
| Professional | | $60.96 | $113.77 | $292.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.23 / $121.70 / $292.61
| Professional | | $70.23 | $121.70 | $292.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.89 / $156.07 / $359.15
| Professional | | $108.89 | $156.07 | $359.15 |