- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,905.46 / $4,570.88
| Facility | | $239.88 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $181.97 / $371.54
| Professional | | $112.20 | $181.97 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $562.34 / $588.84
| Professional | 50 | $302.00 | $562.34 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $288.40
| Professional | | $131.83 | $131.83 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $371.54 / $562.34
| Facility | | $199.53 | $371.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $245.47
| Professional | | $120.23 | $173.78 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $295.12
| Professional | | $120.23 | $186.21 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $501.19 / $1,202.26
| Facility | | $190.55 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $295.12
| Professional | | $107.15 | $173.78 | $295.12 |