- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,862.09 / $7,585.78
| Facility | | $91.20 | $1,862.09 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $269.15 / $954.99 / $2,951.21
| Facility | 50 | $269.15 | $954.99 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $87.10 / $239.88
| Professional | | $48.98 | $87.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $77.62 / $186.21 / $436.52
| Professional | 50 | $77.62 | $186.21 | $436.52 |
- 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
- $46.77 / $77.62 / $147.91
| Professional | | $46.77 | $77.62 | $147.91 |
- 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
- $58.88 / $104.71 / $218.78
| Professional | | $58.88 | $104.71 | $218.78 |
- 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
- $47.86 / $85.11 / $169.82
| Professional | | $47.86 | $85.11 | $169.82 |