- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,288.25 / $1,995.26
| Facility | | $281.84 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $457.09
| Professional | | $144.54 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.08 / $363.08 / $398.11
| Professional | 50 | $363.08 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $478.63
| Professional | | $141.25 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,621.81 / $3,548.13
| Facility | | $630.96 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $275.42 / $602.56
| Professional | | $141.25 | $275.42 | $602.56 |