- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.38 / $409.72 / $1,004.65
| Facility | | $52.38 | $409.72 | $1,004.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.57 / $28.64 / $62.92
| Professional | | $15.57 | $28.64 | $62.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.25 / $42.93 / $60.45
| Professional | | $28.25 | $42.93 | $60.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $42.37 / $64.39 / $90.67
| Professional | 50 | $42.37 | $64.39 | $90.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.71 / $46.47 / $82.10
| Professional | | $28.71 | $46.47 | $82.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.50 / $49.05 / $82.58
| Professional | | $30.50 | $49.05 | $82.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.38 / $409.72 / $2,221.61
| Facility | | $52.38 | $409.72 | $2,221.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.75 / $33.09 / $54.86
| Professional | | $17.75 | $33.09 | $54.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.18 / $56.41 / $80.13
| Professional | | $37.18 | $56.41 | $80.13 |