- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $870.96 / $8,511.38
| Facility | | $43.65 | $870.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $48.98 / $128.82
| Professional | | $28.84 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $30.20 / $42.66 / $331.13
| Professional | 50 | $30.20 | $42.66 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $47.86 / $102.33
| Professional | | $27.54 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $39.81 / $69.18 / $144.54
| Professional | 50 | $39.81 | $69.18 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $89.13 / $251.19
| Facility | | $45.71 | $89.13 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $54.95 / $107.15
| Professional | | $30.20 | $54.95 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,047.13 / $3,467.37
| Facility | | $186.21 | $1,047.13 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $44.67 / $79.43
| Professional | | $28.18 | $44.67 | $79.43 |