- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.56 / $923.00 / $1,768.00
| Facility | | $271.56 | $923.00 | $1,768.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $282.00 / $886.17 / $2,427.19
| Facility | 50 | $282.00 | $886.17 | $2,427.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.50 / $271.56 / $403.21
| Professional | | $167.50 | $271.56 | $403.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.69 / $3,144.71 / $4,230.64
| Facility | | $2,597.69 | $3,144.71 | $4,230.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,896.53 / $4,717.06 / $6,345.96
| Facility | 50 | $3,896.53 | $4,717.06 | $6,345.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.45 / $410.55 / $570.90
| Professional | | $272.45 | $410.55 | $570.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.74 / $288.47 / $1,065.31
| Professional | | $164.74 | $288.47 | $1,065.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,768.00 / $3,360.00
| Facility | | $625.00 | $1,768.00 | $3,360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.45 / $269.43 / $410.56
| Professional | | $192.45 | $269.43 | $410.56 |