- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $354.81 / $812.83
| Facility | | $346.74 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $169.82 / $380.19
| Professional | | $57.54 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $316.23 / $316.23 / $512.86
| Professional | 50 | $316.23 | $316.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $363.08
| Professional | | $181.97 | $181.97 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $229.09 / $537.03
| Professional | 50 | $151.36 | $229.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $181.97 / $338.84
| Professional | | $104.71 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,454.71 / $5,370.32
| Facility | | $1,288.25 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $269.15 / $537.03
| Professional | | $123.03 | $269.15 | $537.03 |