- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $269.15 / $1,995.26
| Facility | | $125.89 | $269.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $251.19 / $436.52
| Professional | | $120.23 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $630.96
| Professional | | $251.19 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $380.19 / $549.54 / $933.25
| Professional | 50 | $380.19 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $398.11 / $724.44
| Professional | | $190.55 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $288.40 / $1,318.26
| Facility | | $131.83 | $288.40 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $446.68 / $1,995.26
| Professional | | $263.03 | $446.68 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,819.70 / $2,570.40
| Facility | | $1,698.24 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $575.44
| Professional | | $151.36 | $288.40 | $575.44 |