- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $3,630.78 / $7,943.28
| Facility | | $102.33 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $72.44 / $141.25
| Professional | | $39.81 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $331.13 / $338.84 / $363.08
| Professional | 50 | $331.13 | $338.84 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $295.12 / $467.74
| Facility | | $218.78 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $162.18
| Professional | | $114.82 | $114.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $104.71 / $177.83
| Professional | | $56.23 | $104.71 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $114.82 / $478.63
| Facility | | $53.70 | $114.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $128.82 / $1,023.29
| Professional | | $70.79 | $128.82 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $416.87 / $1,778.28
| Facility | | $218.78 | $416.87 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $89.13 / $147.91
| Professional | | $47.86 | $89.13 | $147.91 |