- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $954.99 / $1,995.26
| Facility | | $144.54 | $954.99 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $316.23
| Professional | | $100.00 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $707.95
| Professional | 50 | $575.44 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $295.12 / $537.03
| Professional | 50 | $295.12 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $144.54
| Facility | | $131.83 | $131.83 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $501.19 / $501.19
| Professional | | $112.20 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $89.13 / $97.72
| Facility | | $79.43 | $89.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $331.13
| Professional | | $131.83 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $1,949.84
| Facility | | $457.09 | $954.99 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $371.54
| Professional | | $102.33 | $173.78 | $371.54 |