- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $912.01 / $5,888.44
| Facility | | $60.26 | $912.01 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $1,174.90 / $3,981.07
| Facility | 50 | $446.68 | $1,174.90 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $69.18 / $190.55
| Professional | | $37.15 | $69.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $77.62 / $144.54 / $323.59
| Professional | 50 | $77.62 | $144.54 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $10,000.00
| Facility | | $1,548.82 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $63.10 / $120.23
| Professional | | $39.81 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $60.26 / $91.20 / $177.83
| Professional | 50 | $60.26 | $91.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $91.20 / $407.38
| Facility | | $34.67 | $91.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $67.61 / $138.04
| Professional | | $40.74 | $67.61 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,071.52 / $3,467.37
| Facility | | $234.42 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $54.95 / $102.33
| Professional | | $34.67 | $54.95 | $102.33 |