- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $446.68 / $1,949.84
| Facility | | $66.07 | $446.68 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $190.55 / $562.34
| Professional | | $66.07 | $190.55 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $275.42 / $933.25 / $1,148.15
| Professional | 50 | $275.42 | $933.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $162.18 / $363.08
| Professional | | $67.61 | $162.18 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $562.34 / $741.31
| Facility | | $467.74 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $208.93
| Professional | | $61.66 | $61.66 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $173.78 / $416.87
| Professional | | $63.10 | $173.78 | $416.87 |