- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,148.15 / $17,378.01
| Facility | | $204.17 | $1,148.15 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.89 / $1,148.15 / $11,748.98
| Facility | 50 | $0.89 | $1,148.15 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $676.08
| Professional | | $208.93 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.10 / $141.25 / $1,778.28
| Professional | 50 | $87.10 | $141.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $389.05
| Professional | | $154.88 | $257.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.09 / $389.05 / $588.84
| Professional | 50 | $229.09 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $398.11 / $575.44
| Professional | | $218.78 | $398.11 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $562.34
| Professional | | $190.55 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $25,703.96
| Facility | | $190.55 | $346.74 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.89 / $1,148.15 / $11,748.98
| Facility | 50 | $0.89 | $1,148.15 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $794.33
| Professional | | $218.78 | $354.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.10 / $141.25 / $1,778.28
| Professional | 50 | $87.10 | $141.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $426.58 / $676.08
| Professional | | $204.17 | $426.58 | $676.08 |