- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.46 / $188.72 / $655.27
| Facility | | $52.46 | $188.72 | $655.27 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $10.49 / $10.49 / $21.03
| Facility | 53 | $10.49 | $10.49 | $21.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.61 / $85.66 / $121.14
| Professional | | $46.61 | $85.66 | $121.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $156.15 / $156.15 / $240.41
| Professional | 50 | $156.15 | $156.15 | $240.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.29 / $211.02 / $276.87
| Professional | | $99.29 | $211.02 | $276.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $148.94 / $211.31 / $413.52
| Professional | 50 | $148.94 | $211.31 | $413.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.69 / $164.12 / $293.22
| Professional | | $82.69 | $164.12 | $293.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.46 / $105.15 / $190.91
| Facility | | $52.46 | $105.15 | $190.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.83 / $175.40 / $526.00
| Professional | | $106.83 | $175.40 | $526.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.83 / $189.09 / $275.14
| Professional | | $106.83 | $189.09 | $275.14 |