- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $8,511.38
| Facility | | $128.82 | $199.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $263.03 / $467.74
| Professional | | $123.03 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $616.60 / $1,047.13
| Professional | 50 | $407.38 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $467.74
| Professional | | $257.04 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $389.05 / $512.86 / $707.95
| Professional | 50 | $389.05 | $512.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $331.13 / $549.54
| Professional | | $199.53 | $331.13 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $218.78 / $389.05
| Facility | | $128.82 | $218.78 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 50 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $426.58
| Professional | | $186.21 | $363.08 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,344.23 / $2,570.40
| Facility | | $1,819.70 | $2,344.23 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $426.58
| Professional | | $144.54 | $263.03 | $426.58 |