- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,096.48 / $3,467.37
| Facility | | $162.18 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $275.42 / $275.42 / $524.81
| Facility | 50 | $275.42 | $275.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $138.04 / $275.42
| Professional | | $56.23 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.20 / $309.03 / $537.03
| Professional | 50 | $112.20 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $138.04 / $194.98
| Professional | | $44.67 | $138.04 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $223.87 / $346.74
| Facility | | $107.15 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $234.42
| Professional | | $63.10 | $107.15 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $56.23 / $56.23
| Facility | | $39.81 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $117.49 / $239.88
| Professional | | $56.23 | $117.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $1,202.26
| Facility | | $177.83 | $416.87 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $112.20 / $218.78
| Professional | | $53.70 | $112.20 | $218.78 |