- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.28 / $750.00 / $2,403.40
| Facility | | $181.28 | $750.00 | $2,403.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $770.51 / $963.75 / $4,286.39
| Facility | 50 | $770.51 | $963.75 | $4,286.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.28 / $414.80 / $733.47
| Professional | | $181.28 | $414.80 | $733.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $315.56 / $631.13 / $656.26
| Professional | 50 | $315.56 | $631.13 | $656.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.58 / $1,371.58 / $1,371.58
| Facility | | $1,371.58 | $1,371.58 | $1,371.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.00 / $574.00 / $574.00
| Professional | | $574.00 | $574.00 | $574.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.59 / $1,442.59 / $3,384.29
| Facility | | $1,442.59 | $1,442.59 | $3,384.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.97 / $388.63 / $676.33
| Professional | | $188.97 | $388.63 | $676.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.13 / $482.89 / $801.82
| Professional | | $260.13 | $482.89 | $801.82 |