- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.73 / $253.27 / $1,728.00
| Facility | | $93.73 | $253.27 | $1,728.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $206.00 / $506.80 / $3,409.38
| Facility | 50 | $206.00 | $506.80 | $3,409.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.76 / $93.81 / $253.27
| Professional | | $51.76 | $93.81 | $253.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.28 / $179.50 / $241.49
| Facility | | $148.28 | $179.50 | $241.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $222.42 / $269.26 / $362.24
| Facility | 50 | $222.42 | $269.26 | $362.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.00 / $103.57 / $174.59
| Professional | | $57.00 | $103.57 | $174.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.45 / $106.89 / $310.00
| Professional | | $65.45 | $106.89 | $310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,349.00
| Facility | | $241.00 | $850.00 | $1,349.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $134.44 / $218.24
| Professional | | $100.00 | $134.44 | $218.24 |