- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.66 / $163.66 / $2,421.65
| Facility | | $163.66 | $163.66 | $2,421.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $982.40 / $6,133.73 / $6,133.73
| Facility | 50 | $982.40 | $6,133.73 | $6,133.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.08 / $163.66 / $1,377.00
| Professional | | $148.08 | $163.66 | $1,377.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $4,505.39 / $4,505.39 / $4,505.39
| Professional | 50 | $4,505.39 | $4,505.39 | $4,505.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.62 / $355.27 / $444.09
| Professional | | $348.62 | $355.27 | $444.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.71 / $276.60 / $426.22
| Facility | | $191.71 | $276.60 | $426.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.21 / $313.68 / $2,496.46
| Professional | | $188.21 | $313.68 | $2,496.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $411.97 / $1,416.99
| Facility | | $294.00 | $411.97 | $1,416.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.00 / $348.62 / $425.15
| Professional | | $281.00 | $348.62 | $425.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.21 / $268.63 / $309.87
| Professional | | $197.21 | $268.63 | $309.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.99 / $415.78 / $434.39
| Professional | | $205.99 | $415.78 | $434.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.20 / $347.30 / $361.20
| Professional | | $295.20 | $347.30 | $361.20 |