- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.03 / $280.94 / $3,262.34
| Facility | | $90.03 | $280.94 | $3,262.34 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.74 / $1,226.48 / $6,524.69
| Facility | 50 | $0.74 | $1,226.48 | $6,524.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.20 / $172.53 / $280.95
| Professional | | $62.20 | $172.53 | $280.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.12 / $87.12 / $87.12
| Professional | 50 | $87.12 | $87.12 | $87.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.57 / $98.35 / $161.71
| Professional | | $57.57 | $98.35 | $161.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $85.39 / $147.05 / $215.77
| Professional | 50 | $85.39 | $147.05 | $215.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.61 / $100.61 / $100.61
| Facility | | $100.61 | $100.61 | $100.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.47 / $212.26 / $579.41
| Professional | | $82.47 | $212.26 | $579.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.63 / $231.87 / $621.20
| Professional | | $69.63 | $231.87 | $621.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.10 / $301.89 / $508.61
| Professional | | $202.10 | $301.89 | $508.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.16 / $137.81 / $226.53
| Professional | | $51.16 | $137.81 | $226.53 |