- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,128.61 / $6,760.83
| Facility | | $1,380.38 | $5,128.61 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $10,000.00
| Facility | 50 | $3,311.31 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $1,348.96
| Professional | | $489.78 | $630.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $4,677.35
| Professional | | $489.78 | $588.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $1,479.11
| Professional | | $446.68 | $588.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $1,202.26
| Professional | | $537.03 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,000.00 / $26,915.35
| Facility | | $3,311.31 | $10,000.00 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,230.27
| Professional | | $398.11 | $562.34 | $1,230.27 |