- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $3,467.37
| Facility | | $398.11 | $1,288.25 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,949.84
| Facility | 50 | $1,148.15 | $1,148.15 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $251.19 / $1,071.52
| Professional | | $125.89 | $251.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $1,122.02 / $1,698.24
| Professional | 50 | $288.40 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $138.04 / $263.03
| Professional | | $107.15 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | 50 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,230.27 / $1,949.84
| Facility | | $426.58 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $398.11
| Professional | | $138.04 | $234.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $776.25 / $776.25
| Facility | | $39.81 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $426.58
| Professional | | $138.04 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,096.48 / $2,344.23
| Facility | | $338.84 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $223.87 / $426.58
| Professional | | $120.23 | $223.87 | $426.58 |