- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.79 / $2,145.78 / $7,838.38
| Facility | | $131.79 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.61 / $153.32 / $264.04
| Professional | | $113.61 | $153.32 | $264.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $198.48 / $704.52 / $901.50
| Professional | 50 | $198.48 | $704.52 | $901.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.42 / $947.57 / $1,544.06
| Facility | | $258.42 | $947.57 | $1,544.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.84 / $146.31 / $228.69
| Professional | | $73.84 | $146.31 | $228.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.60 / $211.00 / $295.81
| Professional | | $135.60 | $211.00 | $295.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $195.79
| Professional | | $32.34 | $32.34 | $195.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.42 / $179.12 / $260.63
| Facility | | $120.42 | $179.12 | $260.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.66 / $235.41 / $315.06
| Professional | | $146.66 | $235.41 | $315.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.72 / $201.38 / $309.41
| Professional | | $160.72 | $201.38 | $309.41 |