- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,235.94 / $8,912.51
| Facility | | $724.44 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,548.82 / $4,677.35 / $9,120.11
| Facility | 50 | $1,548.82 | $4,677.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,819.70
| Professional | | $457.09 | $707.95 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,479.11
| Professional | | $467.74 | $741.31 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $5,495.41
| Facility | | $758.58 | $1,862.09 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $1,995.26
| Professional | | $512.86 | $891.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $10,000.00
| Facility | | $1,584.89 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $1,380.38
| Professional | | $446.68 | $724.44 | $1,380.38 |