- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,801.89 / $10,232.93
| Facility | | $257.04 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $549.54 / $2,290.87 / $7,079.46
| Facility | 50 | $549.54 | $2,290.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $162.18 / $426.58
| Professional | | $131.83 | $162.18 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,000.00
| Facility | | $2,238.72 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $194.98 / $363.08
| Professional | | $125.89 | $194.98 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $489.78 / $2,290.87
| Facility | | $239.88 | $489.78 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $512.86
| Professional | | $151.36 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,918.31
| Facility | | $1,023.29 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $181.97 / $338.84
| Professional | | $125.89 | $181.97 | $338.84 |