- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $2,691.53 / $6,606.93
| Facility | | $147.91 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,995.26
| Facility | 50 | $1,412.54 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $416.87 / $1,230.27
| Professional | | $144.54 | $416.87 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $144.54 / $275.42
| Professional | | $123.03 | $144.54 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,290.87 / $3,090.30
| Facility | | $1,905.46 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $4,677.35
| Facility | 50 | $2,884.03 | $3,388.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $588.84 / $1,000.00
| Professional | | $144.54 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $363.08 / $977.24
| Professional | | $154.88 | $363.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,698.24 / $3,090.30
| Facility | | $645.65 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $436.52 / $870.96
| Professional | | $128.82 | $436.52 | $870.96 |