- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,630.78 / $7,943.28
| Facility | | $229.09 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $114.82 / $208.93
| Professional | | $83.18 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | 50 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | 50 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $194.98
| Professional | | $186.21 | $186.21 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $131.83 / $177.83
| Professional | | $93.33 | $131.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $162.18 / $1,096.48
| Facility | | $57.54 | $162.18 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $131.83 / $1,905.46
| Professional | | $102.33 | $131.83 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $407.38 / $1,778.28
| Facility | | $218.78 | $407.38 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $120.23 / $169.82
| Professional | | $97.72 | $120.23 | $169.82 |