- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $181.97 / $524.81
| Facility | | $45.71 | $181.97 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $104.71 / $269.15
| Professional | | $47.86 | $104.71 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.00 / $147.91 / $457.09
| Professional | 50 | $100.00 | $147.91 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $123.03 / $190.55
| Professional | | $93.33 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $186.21 / $281.84
| Professional | 50 | $138.04 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $131.83 / $218.78
| Professional | | $81.28 | $131.83 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $114.82 / $245.47
| Facility | | $46.77 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $147.91 / $173.78
| Professional | | $83.18 | $147.91 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $102.33 / $173.78
| Professional | | $52.48 | $102.33 | $173.78 |