- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,570.40 / $7,943.28
| Facility | | $416.87 | $2,570.40 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,949.84 / $4,365.16 / $10,232.93
| Facility | 50 | $1,949.84 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $416.87 / $1,348.96
| Professional | | $97.72 | $416.87 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $446.68 / $3,467.37
| Professional | 50 | $141.25 | $446.68 | $3,467.37 |
- 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
- $109.65 / $446.68 / $1,174.90
| Professional | | $109.65 | $446.68 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $660.69 / $1,513.56
| Professional | 50 | $154.88 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,819.70 / $5,370.32
| Facility | | $165.96 | $1,819.70 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $407.38 / $1,380.38
| Professional | | $114.82 | $407.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,041.74 / $5,011.87
| Facility | | $676.08 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $398.11 / $977.24
| Professional | | $100.00 | $398.11 | $977.24 |