- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $120.23 / $8,511.38
| Facility | | $109.65 | $120.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $120.23 / $181.97
| Professional | | $97.72 | $120.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $239.88 / $281.84
| Professional | | $208.93 | $239.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $354.81 / $426.58
| Professional | 50 | $309.03 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $346.74
| Professional | | $102.33 | $213.80 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $204.17 / $331.13
| Facility | | $109.65 | $204.17 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $213.80 / $831.76
| Professional | | $109.65 | $213.80 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,311.31 / $5,128.61
| Facility | | $1,122.02 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $281.84
| Professional | | $109.65 | $194.98 | $281.84 |