- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.56 / $1,100.74 / $2,108.42
| Facility | | $492.56 | $1,100.74 | $2,108.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $22.56 / $22.56 / $22.56
| Facility | 50 | $22.56 | $22.56 | $22.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.39 / $188.54 / $425.07
| Professional | | $122.39 | $188.54 | $425.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $37.94 / $613.70 / $651.53
| Professional | 50 | $37.94 | $613.70 | $651.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.14 / $165.69 / $202.50
| Facility | | $124.14 | $165.69 | $202.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.28 / $414.49 / $428.47
| Professional | | $147.28 | $414.49 | $428.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.33 / $222.33 / $222.33
| Facility | | $222.33 | $222.33 | $222.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.27 / $234.30 / $628.34
| Professional | | $147.27 | $234.30 | $628.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.03 / $1,008.63 / $2,311.87
| Facility | | $424.03 | $1,008.63 | $2,311.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $848.06 / $2,017.26 / $3,210.74
| Facility | 50 | $848.06 | $2,017.26 | $3,210.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.77 / $203.52 / $318.25
| Professional | | $146.77 | $203.52 | $318.25 |