- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,511.89 / $5,370.32
| Facility | | $223.87 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,000.00 / $4,365.16 / $8,709.64
| Facility | 50 | $1,000.00 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $323.59
| Professional | | $141.25 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $169.82 / $363.08 / $524.81
| Professional | 50 | $169.82 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $158.49 / $165.96
| Professional | | $141.25 | $158.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $194.98 / $234.42 / $295.12
| Professional | 50 | $194.98 | $234.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,570.40 / $3,981.07
| Facility | | $1,318.26 | $2,570.40 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $208.93
| Professional | | $147.91 | $177.83 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,096.48 / $1,096.48
| Facility | | $39.81 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $281.84
| Professional | | $141.25 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $3,981.07
| Facility | | $467.74 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $181.97 / $302.00
| Professional | | $134.90 | $181.97 | $302.00 |