- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,311.31 / $8,912.51
| Facility | | $323.59 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,479.11 / $5,128.61 / $7,943.28
| Facility | 50 | $1,479.11 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $275.42 / $588.84
| Professional | | $144.54 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $1,479.11 / $2,818.38
| Professional | 50 | $457.09 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $275.42 / $602.56
| Professional | | $151.36 | $275.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $380.19 / $776.25
| Professional | 50 | $218.78 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $602.56 / $2,137.96
| Facility | | $165.96 | $602.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $331.13 / $724.44
| Professional | | $173.78 | $331.13 | $724.44 |
- 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
- $144.54 / $269.15 / $524.81
| Professional | | $144.54 | $269.15 | $524.81 |