- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,570.88 / $10,471.29
| Facility | | $363.08 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $199.53 / $602.56
| Professional | | $75.86 | $199.53 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $56.23 / $177.83 / $562.34
| Professional | 50 | $56.23 | $177.83 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Professional | 50 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $239.88 / $588.84
| Professional | | $85.11 | $239.88 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $323.59 / $501.19
| Professional | | $131.83 | $323.59 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $660.69
| Facility | | $269.15 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $223.87 / $426.58
| Professional | | $61.66 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $162.18 / $389.05
| Professional | | $60.26 | $162.18 | $389.05 |