- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $8,511.38
| Facility | | $51.29 | $67.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $77.62 / $181.97
| Professional | | $51.29 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $125.89 / $158.49
| Professional | | $95.50 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $186.21 / $234.42
| Professional | 50 | $141.25 | $186.21 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $109.65 / $186.21
| Professional | | $52.48 | $109.65 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $87.10 / $257.04
| Facility | | $51.29 | $87.10 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $120.23 / $380.19
| Professional | | $69.18 | $120.23 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,148.15 / $2,041.74
| Facility | | $269.15 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $93.33 / $141.25
| Professional | | $63.10 | $93.33 | $141.25 |