- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $257.04 / $6,025.60
| Facility | | $123.03 | $257.04 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $275.42 / $912.01
| Professional | 50 | $123.03 | $275.42 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $154.88 / $162.18
| Facility | | $112.20 | $154.88 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $204.17 / $204.17
| Facility | | $34.67 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 50 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |