- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $8,912.51
| Facility | | $302.00 | $602.56 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $891.25
| Professional | | $295.12 | $407.38 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $81.28 / $81.28 / $812.83
| Professional | 50 | $81.28 | $81.28 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $331.13 / $371.54 / $524.81
| Professional | 54 | $331.13 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,412.54 / $2,630.27
| Facility | | $1,288.25 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $741.31
| Professional | | $338.84 | $524.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $831.76 / $1,096.48
| Professional | 50 | $512.86 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,071.52
| Professional | | $354.81 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $912.01
| Professional | | $416.87 | $630.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $933.25
| Professional | | $338.84 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $436.52
| Facility | | $269.15 | $269.15 | $436.52 |