- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,162.28 / $8,912.51
| Facility | | $281.84 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,737.80 / $5,754.40 / $10,964.78
| Facility | 50 | $1,737.80 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $758.58
| Professional | | $165.96 | $288.40 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $245.47 / $562.34 / $1,862.09
| Professional | 50 | $245.47 | $562.34 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,365.16 / $10,000.00
| Facility | | $1,905.46 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $588.84
| Professional | | $194.98 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $457.09 / $831.76
| Professional | 50 | $288.40 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $933.25 / $11,481.54
| Facility | | $281.84 | $933.25 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $338.84 / $691.83
| Professional | | $194.98 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,456.54
| Facility | | $1,023.29 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $524.81
| Professional | | $165.96 | $281.84 | $524.81 |