- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.00 / $2,912.00 / $6,483.00
| Facility | | $1,389.00 | $2,912.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,134.75 / $4,134.75 / $6,474.75
| Facility | 50 | $4,134.75 | $4,134.75 | $6,474.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.38 / $312.68 / $1,200.18
| Professional | | $199.38 | $312.68 | $1,200.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $303.30 / $1,950.75 / $2,082.38
| Professional | 50 | $303.30 | $1,950.75 | $2,082.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.34 / $192.34 / $202.30
| Professional | | $192.34 | $192.34 | $202.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,211.19 / $3,616.69
| Facility | | $601.16 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.40 / $253.00 / $343.45
| Professional | | $202.40 | $253.00 | $343.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.83 / $1,304.83 / $1,304.83
| Facility | | $1,304.83 | $1,304.83 | $1,304.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.26 / $291.31 / $459.96
| Professional | | $198.26 | $291.31 | $459.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.57 / $361.45 / $2,421.00
| Facility | | $211.57 | $361.45 | $2,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.29 / $339.72 / $2,279.67
| Professional | | $275.29 | $339.72 | $2,279.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.00 / $2,405.00 / $4,640.00
| Facility | | $1,282.00 | $2,405.00 | $4,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.86 / $321.83 / $591.65
| Professional | | $270.86 | $321.83 | $591.65 |