- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.48 / $223.68 / $643.12
| Facility | | $114.48 | $223.68 | $643.12 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,128.73 / $1,128.73 / $1,128.73
| Facility | 50 | $1,128.73 | $1,128.73 | $1,128.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.40 / $126.24 / $207.82
| Professional | | $95.40 | $126.24 | $207.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.00 / $3,373.00 / $4,707.00
| Facility | | $1,723.00 | $3,373.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.49 / $138.54 / $213.82
| Professional | | $100.49 | $138.54 | $213.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $121.48 / $167.40
| Facility | | $100.00 | $121.48 | $167.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.19 / $170.37 / $268.07
| Professional | | $118.19 | $170.37 | $268.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.66 / $171.19 / $294.43
| Professional | | $122.66 | $171.19 | $294.43 |