- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $8,511.38
| Facility | | $114.82 | $131.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $208.93
| Professional | | $102.33 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | 50 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $309.03
| Professional | | $223.87 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $389.05 / $467.74
| Professional | 50 | $338.84 | $389.05 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $229.09 / $371.54
| Professional | | $102.33 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $190.55 / $281.84
| Facility | | $89.13 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $870.96
| Professional | | $120.23 | $229.09 | $870.96 |
- 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
- $117.49 / $208.93 / $309.03
| Professional | | $117.49 | $208.93 | $309.03 |