- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $562.34 / $1,737.80
| Facility | | $51.29 | $562.34 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $56.23 / $128.82
| Professional | | $28.84 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $33.11 / $56.23
| Professional | | $15.85 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $851.14
| Facility | | $524.81 | $630.96 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $794.33 / $933.25 / $1,258.93
| Facility | 50 | $794.33 | $933.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $83.18 / $97.72
| Professional | | $52.48 | $83.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $54.95 / $158.49
| Professional | | $30.20 | $54.95 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $51.29 / $102.33
| Professional | | $28.18 | $51.29 | $102.33 |