- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $7,585.78
| Facility | | $109.65 | $177.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $125.89 / $239.88
| Professional | | $93.33 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $194.98 / $363.08 / $363.08
| Professional | 50 | $194.98 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $109.65
| Professional | | $97.72 | $97.72 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $177.83 / $275.42
| Professional | | $100.00 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $141.25 / $302.00
| Professional | | $95.50 | $141.25 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $131.83 / $251.19
| Facility | | $97.72 | $131.83 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $1,949.84
| Facility | | $302.00 | $758.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $234.42
| Professional | | $87.10 | $114.82 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $1,318.26
| Facility | | $56.23 | $56.23 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,290.87 / $2,290.87
| Professional | | $1,071.52 | $2,290.87 | $2,290.87 |