- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,288.25 / $3,715.35
| Facility | | $245.47 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $97.72 / $181.97
| Professional | | $57.54 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $91.20 / $158.49 / $190.55
| Professional | 50 | $91.20 | $158.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $91.20 / $91.20
| Professional | | $85.11 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $239.88 / $1,230.27
| Facility | | $0.02 | $239.88 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $95.50 / $151.36
| Professional | | $63.10 | $95.50 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $354.81 / $354.81
| Facility | | $39.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $102.33 / $154.88
| Professional | | $64.57 | $102.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $512.86 / $1,258.93
| Facility | | $208.93 | $512.86 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $91.20 / $169.82
| Professional | | $56.23 | $91.20 | $169.82 |