- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,862.09 / $6,456.54
| Facility | | $190.55 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $724.44 / $2,187.76 / $5,248.07
| Facility | 50 | $724.44 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $194.98 / $758.58
| Professional | | $57.54 | $194.98 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $83.18 / $194.98 / $1,023.29
| Professional | 50 | $83.18 | $194.98 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,801.89 / $10,000.00
| Facility | | $1,584.89 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $281.84
| Professional | | $57.54 | $95.50 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.10 / $141.25 / $416.87
| Professional | 50 | $87.10 | $141.25 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $724.44 / $1,819.70
| Facility | | $34.67 | $724.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $181.97 / $501.19
| Professional | | $66.07 | $181.97 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,630.78
| Facility | | $269.15 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $144.54 / $331.13
| Professional | | $56.23 | $144.54 | $331.13 |