- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $912.01 / $5,888.44
| Facility | | $89.13 | $912.01 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $831.76 / $1,905.46
| Facility | 50 | $407.38 | $831.76 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $104.71 / $281.84
| Professional | | $57.54 | $104.71 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $85.11 / $251.19 / $436.52
| Professional | 50 | $85.11 | $251.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $83.18 / $125.89
| Professional | | $63.10 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $85.11 / $151.36
| Professional | 50 | $72.44 | $85.11 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $109.65 / $177.83
| Professional | | $72.44 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $104.71 / $1,047.13
| Professional | | $51.29 | $104.71 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $97.72 / $104.71
| Professional | | $51.29 | $97.72 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $112.20 / $190.55
| Professional | | $69.18 | $112.20 | $190.55 |