- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,235.94 / $8,709.64
| Facility | | $758.58 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,235.94 / $5,623.41 / $21,877.62
| Facility | 50 | $3,235.94 | $5,623.41 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $851.14 / $1,737.80
| Professional | | $144.54 | $851.14 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $4,265.80 / $9,549.93
| Professional | 50 | $457.09 | $4,265.80 | $9,549.93 |
- 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 / $912.01 / $2,187.76
| Professional | | $151.36 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $1,318.26 / $2,630.27
| Professional | 50 | $218.78 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,862.09 / $7,079.46
| Facility | | $165.96 | $1,862.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $794.33 / $2,398.83
| Professional | | $173.78 | $794.33 | $2,398.83 |
- 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
- $144.54 / $758.58 / $1,862.09
| Professional | | $144.54 | $758.58 | $1,862.09 |