- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $114.82 / $8,511.38
| Facility | | $102.33 | $114.82 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $114.82 / $190.55
| Professional | | $97.72 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $223.87 / $269.15
| Professional | | $194.98 | $223.87 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $331.13 / $398.11
| Professional | 50 | $288.40 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $194.98 / $316.23
| Professional | | $97.72 | $194.98 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $263.03
| Facility | | $102.33 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $204.17 / $812.83
| Professional | | $109.65 | $204.17 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,148.15 / $2,041.74
| Facility | | $269.15 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $186.21 / $263.03
| Professional | | $107.15 | $186.21 | $263.03 |