- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,754.23 / $7,413.10
| Facility | | $436.52 | $2,754.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,174.90 / $3,467.37 / $8,709.64
| Facility | 50 | $1,174.90 | $3,467.37 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $426.58 / $1,148.15
| Professional | | $190.55 | $426.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $645.65 / $1,995.26
| Professional | 50 | $346.74 | $645.65 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,168.69 / $10,000.00
| Facility | | $1,621.81 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $660.69
| Professional | | $208.93 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $501.19 / $933.25
| Professional | 50 | $309.03 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $870.96 / $3,311.31
| Facility | | $269.15 | $870.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $1,023.29
| Professional | | $234.42 | $467.74 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $9,549.93
| Facility | | $1,479.11 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $398.11 / $794.33
| Professional | | $208.93 | $398.11 | $794.33 |