- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $2,041.74 / $2,041.74
| Facility | | $21.88 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $33.88 / $173.78
| Professional | | $22.91 | $33.88 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | 50 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $26.30 / $31.62
| Facility | | $26.30 | $26.30 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $1,318.26
| Facility | | $41.69 | $41.69 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $53.70 / $1,047.13
| Professional | | $26.30 | $53.70 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,621.81 / $3,715.35
| Facility | | $676.08 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $2,454.71
| Facility | | $691.83 | $691.83 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $83.18 / $380.19
| Professional | | $22.39 | $83.18 | $380.19 |