- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,288.25 / $3,715.35
| Facility | | $245.47 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $3,388.44 / $6,456.54
| Facility | 50 | $338.84 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $295.12
| Professional | | $107.15 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $549.54 / $549.54
| Professional | 50 | $72.44 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $398.11 / $588.84
| Facility | | $199.53 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $281.84
| Professional | | $117.49 | $186.21 | $281.84 |
- 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
- $109.65 / $177.83 / $288.40
| Professional | | $109.65 | $177.83 | $288.40 |
- 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
- $95.50 / $169.82 / $295.12
| Professional | | $95.50 | $169.82 | $295.12 |