- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $2,290.87
| Facility | | $316.23 | $575.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $109.65 / $239.88
| Professional | | $50.12 | $109.65 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $144.54 / $371.54
| Professional | 50 | $75.86 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $75.86 / $120.23
| Professional | | $43.65 | $75.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $66.07 / $114.82 / $177.83
| Professional | 50 | $66.07 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $120.23 / $239.88
| Professional | | $63.10 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $141.25 / $234.42
| Professional | | $54.95 | $141.25 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $2,454.71
| Facility | | $316.23 | $575.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $112.20 / $251.19
| Professional | | $52.48 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $144.54 / $371.54
| Professional | 50 | $75.86 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $95.50 / $190.55
| Professional | | $52.48 | $95.50 | $190.55 |