- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $186.21 / $1,288.25
| Facility | | $97.72 | $186.21 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | 50 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $208.93 / $467.74
| Professional | | $100.00 | $208.93 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $467.74 / $645.65
| Professional | 50 | $338.84 | $467.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $190.55 / $346.74
| Professional | | $93.33 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,630.78
| Facility | | $3,019.95 | $3,019.95 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | 50 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $5,011.87
| Facility | | $436.52 | $436.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $380.19
| Professional | | $93.33 | $169.82 | $380.19 |