- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.94 / $928.40 / $3,335.12
| Facility | | $324.94 | $928.40 | $3,335.12 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $838.48 / $1,631.84 / $9,537.24
| Facility | 50 | $838.48 | $1,631.84 | $9,537.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.09 / $96.00 / $151.84
| Professional | | $55.09 | $96.00 | $151.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $81.83 / $189.28 / $194.77
| Professional | 50 | $81.83 | $189.28 | $194.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.79 / $68.15 / $93.70
| Facility | | $56.79 | $68.15 | $93.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.88 / $142.16 / $206.01
| Professional | | $87.88 | $142.16 | $206.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.68 / $101.68 / $101.68
| Facility | | $101.68 | $101.68 | $101.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.48 / $106.63 / $255.78
| Professional | | $63.48 | $106.63 | $255.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.80 / $379.94 / $2,669.71
| Facility | | $205.80 | $379.94 | $2,669.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $326.66 / $326.66 / $5,339.41
| Facility | 50 | $326.66 | $326.66 | $5,339.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.33 / $133.10 / $214.36
| Professional | | $73.33 | $133.10 | $214.36 |