- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $316.23 / $812.83
| Facility | | $144.54 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $134.90 / $331.13
| Professional | | $54.95 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $66.07 / $275.42 / $645.65
| Professional | 50 | $66.07 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $144.54 / $363.08
| Professional | | $109.65 | $144.54 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $218.78 / $549.54
| Professional | 50 | $162.18 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $177.83 / $426.58
| Professional | | $79.43 | $177.83 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $144.54 / $436.52
| Facility | | $56.23 | $144.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.58 / $0.58 / $0.58
| Facility | 50 | $0.58 | $0.58 | $0.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $169.82 / $309.03
| Professional | | $100.00 | $169.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $123.03 / $316.23
| Professional | | $61.66 | $123.03 | $316.23 |