- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $186.21 / $2,041.74
| Facility | | $109.65 | $186.21 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $154.88
| Professional | | $77.62 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $147.91
| Professional | | $114.82 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | 50 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $912.01
| Facility | | $660.69 | $660.69 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $112.20 / $158.49
| Professional | | $85.11 | $112.20 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $154.88 / $218.78
| Professional | | $104.71 | $154.88 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $912.01 / $2,089.30
| Facility | | $331.13 | $912.01 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $120.23 / $208.93
| Professional | | $79.43 | $120.23 | $208.93 |