- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $1,096.48 / $5,623.41
| Facility | | $60.26 | $1,096.48 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $416.87 / $416.87 / $467.74
| Facility | 50 | $416.87 | $416.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $363.08 / $707.95
| Facility | | $302.00 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $194.98 / $467.74
| Professional | | $44.67 | $194.98 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $724.44 / $2,187.76
| Facility | | $158.49 | $724.44 | $2,187.76 |