- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,818.38 / $8,709.64
| Facility | | $100.00 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $831.76 / $4,466.84
| Facility | 50 | $309.03 | $831.76 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $70.79 / $147.91
| Professional | | $45.71 | $70.79 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $10,715.19
| Facility | | $1,621.81 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $81.28 / $165.96
| Professional | | $53.70 | $81.28 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $218.78 / $630.96
| Facility | | $34.67 | $218.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $190.55
| Professional | | $56.23 | $95.50 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,630.78
| Facility | | $269.15 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $79.43 / $147.91
| Professional | | $46.77 | $79.43 | $147.91 |