- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $660.69
| Facility | | $114.82 | $134.90 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 50 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $158.49 / $501.19
| Professional | | $114.82 | $158.49 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $436.52 / $1,202.26
| Professional | 50 | $199.53 | $436.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $588.84 / $1,348.96
| Facility | | $275.42 | $588.84 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $1,258.93 / $3,162.28
| Facility | 50 | $691.83 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $478.63
| Professional | | $204.17 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $436.52 / $691.83
| Professional | 50 | $295.12 | $436.52 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,202.26
| Facility | | $354.81 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $588.84
| Professional | | $229.09 | $380.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $954.99
| Facility | | $389.05 | $478.63 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $549.54
| Professional | | $239.88 | $338.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $416.87
| Facility | | $128.82 | $239.88 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $575.44 / $10,964.78
| Facility | 50 | $72.44 | $575.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $1,412.54
| Professional | | $134.90 | $263.03 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $229.09 / $446.68
| Professional | | $125.89 | $229.09 | $446.68 |