- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $6,760.83
| Facility | | $1,000.00 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $3,630.78
| Facility | 50 | $1,047.13 | $1,047.13 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $154.88 / $269.15
| Professional | | $141.25 | $154.88 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,011.87 / $7,943.28
| Facility | | $3,235.94 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $194.98
| Professional | | $141.25 | $177.83 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $234.42
| Professional | | $151.36 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $1,318.26 / $5,888.44
| Facility | | $144.54 | $1,318.26 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $1,122.02
| Professional | | $131.83 | $173.78 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,089.30 / $4,073.80
| Facility | | $575.44 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $154.88 / $223.87
| Professional | | $120.23 | $154.88 | $223.87 |