- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,398.83 / $2,754.23
| Facility | | $1,202.26 | $2,398.83 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $1,380.38 / $2,630.27
| Facility | 50 | $346.74 | $1,380.38 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $194.98 / $354.81
| Professional | | $104.71 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $524.81 / $891.25
| Professional | 50 | $208.93 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $158.49 / $251.19
| Professional | | $93.33 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $239.88 / $338.84
| Professional | 50 | $141.25 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $398.11
| Professional | | $128.82 | $239.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $251.19 / $407.38
| Professional | | $117.49 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,398.83 / $2,754.23
| Facility | | $1,202.26 | $2,398.83 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $1,380.38 / $2,630.27
| Facility | 50 | $346.74 | $1,380.38 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $371.54
| Professional | | $112.20 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $524.81 / $891.25
| Professional | 50 | $208.93 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $186.21 / $371.54
| Professional | | $104.71 | $186.21 | $371.54 |