- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,288.25 / $3,890.45
| Facility | | $295.12 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $131.83 / $263.03
| Professional | | $91.20 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $602.56
| Professional | 50 | $575.44 | $575.44 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $426.58 / $645.65
| Facility | | $186.21 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $223.87
| Professional | | $107.15 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $177.83 / $177.83
| Facility | | $39.81 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $223.87
| Professional | | $104.71 | $147.91 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $501.19 / $1,202.26
| Facility | | $213.80 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $117.49 / $218.78
| Professional | | $83.18 | $117.49 | $218.78 |