- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $608.54 / $2,117.30
| Facility | | $0.98 | $608.54 | $2,117.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.15 / $504.49 / $1,194.84
| Professional | | $123.15 | $504.49 | $1,194.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $348.38 / $348.38 / $348.38
| Professional | 50 | $348.38 | $348.38 | $348.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.07 / $110.07 / $139.44
| Professional | | $110.07 | $110.07 | $139.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.16 / $136.16 / $136.16
| Facility | | $136.16 | $136.16 | $136.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.69 / $344.47 / $997.93
| Professional | | $119.69 | $344.47 | $997.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.55 / $610.82 / $1,036.09
| Professional | | $182.55 | $610.82 | $1,036.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.43 / $714.66 / $1,336.55
| Professional | | $473.43 | $714.66 | $1,336.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.02 / $518.88 / $748.06
| Professional | | $112.02 | $518.88 | $748.06 |