- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.05 / $2,196.25 / $6,953.60
| Facility | | $606.05 | $2,196.25 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $713.22 / $713.22 / $713.22
| Facility | 50 | $713.22 | $713.22 | $713.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.92 / $417.45 / $875.14
| Professional | | $123.92 | $417.45 | $875.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.54 / $418.35 / $1,415.61
| Professional | | $192.54 | $418.35 | $1,415.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.23 / $390.46 / $1,284.26
| Professional | | $178.23 | $390.46 | $1,284.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.92 / $310.31 / $917.82
| Facility | | $123.92 | $310.31 | $917.82 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $309.00 / $510.55 / $1,728.04
| Facility | 50 | $309.00 | $510.55 | $1,728.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.09 / $702.09 / $1,356.84
| Professional | | $702.09 | $702.09 | $1,356.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $263.70 / $1,455.30
| Professional | | $6.00 | $263.70 | $1,455.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.00 / $3,733.00 / $6,543.00
| Facility | | $1,728.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.18 / $594.14 / $1,536.68
| Professional | | $169.18 | $594.14 | $1,536.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.22 / $997.22 / $12,000.00
| Facility | | $997.22 | $997.22 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.64 / $3,562.64 / $4,166.85
| Professional | | $1,844.64 | $3,562.64 | $4,166.85 |