- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.86 / $748.91 / $1,119.88
| Facility | | $35.86 | $748.91 | $1,119.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.02 / $50.50 / $129.05
| Professional | | $34.02 | $50.50 | $129.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $185.57 / $185.57 / $314.00
| Professional | 50 | $185.57 | $185.57 | $314.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $104.23 / $134.29
| Professional | | $70.34 | $104.23 | $134.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $105.53 / $136.58 / $201.44
| Professional | 50 | $105.53 | $136.58 | $201.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.45 / $99.62 / $141.24
| Professional | | $51.45 | $99.62 | $141.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.86 / $59.42 / $107.58
| Facility | | $35.86 | $59.42 | $107.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,132.31 / $1,132.31 / $1,132.31
| Facility | 50 | $1,132.31 | $1,132.31 | $1,132.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $95.34 / $168.27
| Professional | | $52.44 | $95.34 | $168.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $119.52 / $137.35 / $206.03
| Professional | 50 | $119.52 | $137.35 | $206.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.97 / $85.81 / $114.33
| Professional | | $51.97 | $85.81 | $114.33 |