- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.88 / $330.88 / $4,338.00
| Facility | | $330.88 | $330.88 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,405.50 / $13,994.39 / $13,994.39
| Facility | 50 | $7,405.50 | $13,994.39 | $13,994.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.88 / $403.79 / $6,151.88
| Professional | | $330.88 | $403.79 | $6,151.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $444.12 / $18,651.68 / $18,651.68
| Professional | 50 | $444.12 | $18,651.68 | $18,651.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.06 / $714.43 / $893.04
| Professional | | $703.06 | $714.43 | $893.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.24 / $599.35 / $1,062.70
| Facility | | $386.24 | $599.35 | $1,062.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.32 / $778.86 / $6,125.60
| Professional | | $467.32 | $778.86 | $6,125.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.06 / $841.00 / $4,395.05
| Facility | | $703.06 | $841.00 | $4,395.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.98 / $747.05 / $863.51
| Professional | | $671.98 | $747.05 | $863.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.48 / $593.70 / $680.15
| Professional | | $431.48 | $593.70 | $680.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.00 / $3,143.00 / $3,143.00
| Facility | | $3,143.00 | $3,143.00 | $3,143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.37 / $673.18 / $890.34
| Professional | | $428.37 | $673.18 | $890.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.29 / $700.40 / $728.40
| Professional | | $595.29 | $700.40 | $728.40 |