- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.84 / $246.05 / $7,500.35
| Facility | | $73.84 | $246.05 | $7,500.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,202.26 / $3,202.26 / $3,273.30
| Facility | 50 | $3,202.26 | $3,202.26 | $3,273.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.84 / $164.80 / $246.05
| Professional | | $73.84 | $164.80 | $246.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.42 / $220.78 / $296.33
| Professional | | $70.42 | $220.78 | $296.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.97 / $2,949.97 / $2,949.97
| Facility | | $2,949.97 | $2,949.97 | $2,949.97 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,736.37 / $2,736.37 / $2,736.37
| Facility | 50 | $2,736.37 | $2,736.37 | $2,736.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Facility | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.39 / $220.08 / $515.51
| Professional | | $165.39 | $220.08 | $515.51 |