- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.43 / $127.29 / $215.07
| Facility | | $94.43 | $127.29 | $215.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $411.82 / $411.82 / $1,966.60
| Facility | 50 | $411.82 | $411.82 | $1,966.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.53 / $127.29 / $172.64
| Professional | | $93.53 | $127.29 | $172.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $205.32 / $205.32 / $205.32
| Professional | 50 | $205.32 | $205.32 | $205.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.82 / $137.05 / $188.68
| Facility | | $104.82 | $137.05 | $188.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.84 / $121.82 / $121.82
| Professional | | $82.84 | $121.82 | $121.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.35 / $178.35 / $178.35
| Facility | | $178.35 | $178.35 | $178.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.11 / $152.27 / $287.39
| Professional | | $103.11 | $152.27 | $287.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.68 / $788.68 / $788.68
| Facility | | $788.68 | $788.68 | $788.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.86 / $126.31 / $208.96
| Professional | | $83.86 | $126.31 | $208.96 |