- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $1,230.27 / $5,623.41
| Facility | | $70.79 | $1,230.27 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $1,548.82
| Facility | 50 | $1,148.15 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $89.13 / $309.03
| Professional | | $50.12 | $89.13 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $93.33 / $208.93 / $501.19
| Professional | 50 | $93.33 | $208.93 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $43.65 / $51.29
| Professional | | $39.81 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Professional | 50 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $60.26 / $100.00
| Professional | | $47.86 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $70.79 / $91.20 / $147.91
| Professional | 50 | $70.79 | $91.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $97.72 / $134.90
| Professional | | $46.77 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $97.72 / $173.78
| Professional | | $57.54 | $97.72 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $95.50 / $467.74
| Facility | | $51.29 | $95.50 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $2,511.89
| Professional | | $85.11 | $144.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,778.28
| Facility | | $338.84 | $707.95 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $91.20 / $162.18
| Professional | | $51.29 | $91.20 | $162.18 |