- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $1,348.96 / $6,456.54
| Facility | | $89.13 | $1,348.96 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $1,288.25 / $3,090.30
| Facility | 50 | $457.09 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $97.72 / $389.05
| Professional | | $48.98 | $97.72 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.13 / $162.18 / $537.03
| Professional | 50 | $74.13 | $162.18 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $10,000.00
| Facility | | $1,548.82 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $77.62 / $144.54
| Professional | | $45.71 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $66.07 / $114.82 / $213.80
| Professional | 50 | $66.07 | $114.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $281.84 / $812.83
| Facility | | $34.67 | $281.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $104.71 / $223.87
| Professional | | $57.54 | $104.71 | $223.87 |
- 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 / $85.11 / $169.82
| Professional | | $46.77 | $85.11 | $169.82 |