- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.70 / $3,523.79 / $3,523.79
| Facility | | $271.70 | $3,523.79 | $3,523.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $576.50 / $2,421.65 / $3,375.54
| Facility | 50 | $576.50 | $2,421.65 | $3,375.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.70 / $291.39 / $4,305.25
| Professional | | $271.70 | $291.39 | $4,305.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,235.60 / $2,235.60 / $17,003.32
| Professional | 50 | $2,235.60 | $2,235.60 | $17,003.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.15 / $585.88 / $732.35
| Professional | | $577.15 | $585.88 | $732.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.45 / $474.00 / $844.26
| Facility | | $317.45 | $474.00 | $844.26 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,249.34 / $7,249.34 / $7,249.34
| Facility | 50 | $7,249.34 | $7,249.34 | $7,249.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.72 / $617.86 / $5,305.00
| Professional | | $370.72 | $617.86 | $5,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.15 / $689.32 / $4,395.05
| Facility | | $577.15 | $689.32 | $4,395.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.00 / $611.97 / $708.59
| Professional | | $542.00 | $611.97 | $708.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.43 / $487.38 / $540.35
| Professional | | $342.43 | $487.38 | $540.35 |
- 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
- $339.82 / $648.75 / $728.76
| Professional | | $339.82 | $648.75 | $728.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.70 / $574.90 / $597.90
| Professional | | $488.70 | $574.90 | $597.90 |