- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.27 / $594.27 / $1,782.82
| Facility | | $594.27 | $594.27 | $1,782.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,782.82 / $1,782.82 / $1,782.82
| Facility | 50 | $1,782.82 | $1,782.82 | $1,782.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $211.74 / $374.22
| Professional | | $71.20 | $211.74 | $374.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.41 / $118.46 / $180.16
| Professional | | $98.41 | $118.46 | $180.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.82 / $237.15 / $633.23
| Professional | | $101.82 | $237.15 | $633.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.58 / $306.06 / $657.72
| Professional | | $100.58 | $306.06 | $657.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.27 / $594.27 / $1,782.82
| Facility | | $594.27 | $594.27 | $1,782.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,782.82 / $1,782.82 / $1,782.82
| Facility | 50 | $1,782.82 | $1,782.82 | $1,782.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.11 / $206.87 / $374.22
| Professional | | $80.11 | $206.87 | $374.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.70 / $365.33 / $644.12
| Professional | | $301.70 | $365.33 | $644.12 |