- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.62 / $1,423.62 / $1,423.62
| Facility | | $1,423.62 | $1,423.62 | $1,423.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $73.29 / $119.07
| Professional | | $47.53 | $73.29 | $119.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.12 / $98.46 / $137.16
| Professional | | $63.12 | $98.46 | $137.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $94.68 / $147.69 / $205.74
| Professional | 50 | $94.68 | $147.69 | $205.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.37 / $109.17 / $179.22
| Professional | | $66.37 | $109.17 | $179.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.30 / $111.29 / $178.66
| Professional | | $64.30 | $111.29 | $178.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.62 / $1,423.62 / $1,423.62
| Facility | | $1,423.62 | $1,423.62 | $1,423.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.04 / $83.61 / $142.53
| Professional | | $56.04 | $83.61 | $142.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.92 / $110.72 / $182.27
| Professional | | $78.92 | $110.72 | $182.27 |