- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $3,981.07
| Facility | | $346.74 | $346.74 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $85.11 / $199.53
| Professional | | $51.29 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $58.88 / $91.20
| Professional | | $44.67 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $69.18 / $123.03
| Professional | | $40.74 | $69.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,412.54 / $6,456.54
| Facility | | $316.23 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $72.44 / $104.71
| Professional | | $48.98 | $72.44 | $104.71 |