- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.45 / $2,415.21 / $6,137.75
| Facility | | $0.45 | $2,415.21 | $6,137.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.31 / $159.15 / $230.10
| Professional | | $80.31 | $159.15 | $230.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.72 / $151.66 / $274.83
| Professional | | $90.72 | $151.66 | $274.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $136.08 / $227.49 / $412.26
| Professional | 50 | $136.08 | $227.49 | $412.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.71 / $217.42 / $338.46
| Professional | | $100.71 | $217.42 | $338.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.51 / $193.67 / $335.44
| Professional | | $91.51 | $193.67 | $335.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.92 / $2,439.53 / $7,048.89
| Facility | | $344.92 | $2,439.53 | $7,048.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.14 / $159.15 / $275.44
| Professional | | $81.14 | $159.15 | $275.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.38 / $235.36 / $357.41
| Professional | | $142.38 | $235.36 | $357.41 |