- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $3,467.37 / $10,000.00
| Facility | | $218.78 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $602.56 / $2,187.76 / $5,495.41
| Facility | 50 | $602.56 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $549.54
| Professional | | $123.03 | $213.80 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $537.03 / $1,230.27
| Professional | 50 | $295.12 | $537.03 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $407.38
| Professional | | $123.03 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $181.97 / $316.23 / $602.56
| Professional | 50 | $181.97 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $660.69 / $4,570.88
| Facility | | $138.04 | $660.69 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $549.54
| Professional | | $144.54 | $251.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,148.15 / $3,467.37
| Facility | | $302.00 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $389.05
| Professional | | $120.23 | $204.17 | $389.05 |