- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,949.84 / $7,585.78
| Facility | | $91.20 | $1,949.84 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $1,023.29 / $9,549.93
| Facility | 50 | $354.81 | $1,023.29 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $97.72 / $275.42
| Professional | | $50.12 | $97.72 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $263.03 / $630.96
| Professional | 50 | $109.65 | $263.03 | $630.96 |
- 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
- $51.29 / $91.20 / $173.78
| Professional | | $51.29 | $91.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.13 / $131.83 / $257.04
| Professional | 50 | $74.13 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $251.19 / $794.33
| Facility | | $50.12 | $251.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $102.33 / $213.80
| Professional | | $58.88 | $102.33 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $83.18 / $154.88
| Professional | | $48.98 | $83.18 | $154.88 |