- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $331.13
| Professional | | $131.83 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $524.81 / $1,258.93
| Professional | 50 | $524.81 | $524.81 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $691.83
| Facility | | $436.52 | $512.86 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $645.65 / $776.25 / $1,047.13
| Facility | 50 | $645.65 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $173.78
| Professional | | $102.33 | $138.04 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $204.17 / $588.84
| Professional | | $109.65 | $204.17 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $223.87
| Professional | | $109.65 | $151.36 | $223.87 |