- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,090.30 / $10,000.00
| Facility | | $707.95 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $724.44 / $3,630.78 / $10,000.00
| Facility | 50 | $724.44 | $3,630.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $1,348.96
| Professional | | $416.87 | $537.03 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,786.30 / $13,803.84
| Facility | | $1,621.81 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $1,202.26
| Professional | | $389.05 | $616.60 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,995.26 / $14,125.38
| Facility | | $933.25 | $1,995.26 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $1,737.80
| Professional | | $467.74 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,589.25
| Facility | | $1,995.26 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,148.15
| Professional | | $407.38 | $602.56 | $1,148.15 |