- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.93 / $2,145.78 / $7,838.38
| Facility | | $236.93 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.15 / $179.19 / $374.07
| Professional | | $128.15 | $179.19 | $374.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $249.42 / $249.42 / $249.42
| Professional | 50 | $249.42 | $249.42 | $249.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.25 / $1,196.29 / $1,949.34
| Facility | | $326.25 | $1,196.29 | $1,949.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.26 / $203.80 / $315.08
| Professional | | $110.26 | $203.80 | $315.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.69 / $226.96 / $364.60
| Professional | | $136.69 | $226.96 | $364.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $181.45 / $319.51
| Professional | | $32.34 | $181.45 | $319.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.75 / $197.70 / $273.14
| Facility | | $134.75 | $197.70 | $273.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.69 / $226.96 / $352.16
| Professional | | $136.69 | $226.96 | $352.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $1,084.00 / $1,401.00
| Facility | | $200.00 | $1,084.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.30 / $261.01 / $370.15
| Professional | | $213.30 | $261.01 | $370.15 |