- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.76 / $1,301.82 / $1,301.82
| Facility | | $104.76 | $1,301.82 | $1,301.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.57 / $79.45 / $104.76
| Professional | | $47.57 | $79.45 | $104.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.64 / $67.81 / $100.27
| Professional | | $57.64 | $67.81 | $100.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $86.46 / $101.72 / $150.40
| Professional | 50 | $86.46 | $101.72 | $150.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.45 / $111.68 / $186.44
| Professional | | $64.45 | $111.68 | $186.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.07 / $110.88 / $178.01
| Professional | | $63.07 | $110.88 | $178.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.71 / $786.71 / $1,301.82
| Facility | | $786.71 | $786.71 | $1,301.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.64 / $80.40 / $151.47
| Professional | | $49.64 | $80.40 | $151.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.56 / $116.98 / $156.68
| Professional | | $83.56 | $116.98 | $156.68 |