- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $1,023.29 / $4,168.69
| Facility | | $46.77 | $1,023.29 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $44.67 / $66.07
| Professional | | $28.84 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | 50 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $26.30 / $27.54
| Professional | | $26.30 | $26.30 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $223.87 / $346.74
| Facility | | $107.15 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $35.48 / $66.07
| Professional | | $30.20 | $35.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $102.33 / $102.33
| Facility | | $39.81 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $45.71 / $83.18
| Professional | | $27.54 | $45.71 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $1,202.26
| Facility | | $177.83 | $416.87 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $40.74 / $79.43
| Professional | | $26.30 | $40.74 | $79.43 |