- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.56 / $3,213.00 / $7,365.00
| Facility | | $328.56 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,967.00 / $1,967.00 / $3,076.25
| Facility | 50 | $1,967.00 | $1,967.00 | $3,076.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.86 / $323.87 / $554.29
| Professional | | $203.86 | $323.87 | $554.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $163.44 / $460.39 / $460.39
| Professional | 50 | $163.44 | $460.39 | $460.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.46 / $180.46 / $253.81
| Professional | | $180.46 | $180.46 | $253.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $5,295.00
| Facility | | $821.00 | $1,963.00 | $5,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.68 / $296.02 / $490.65
| Professional | | $222.68 | $296.02 | $490.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $334.02 / $444.04 / $735.97
| Professional | 50 | $334.02 | $444.04 | $735.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.54 / $374.86 / $664.71
| Professional | | $212.54 | $374.86 | $664.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.03 / $481.71 / $4,324.56
| Facility | | $247.03 | $481.71 | $4,324.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.64 / $672.29 / $2,279.67
| Professional | | $322.64 | $672.29 | $2,279.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.00 / $2,269.00 / $2,963.00
| Facility | | $1,123.00 | $2,269.00 | $2,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.51 / $467.23 / $1,094.70
| Professional | | $319.51 | $467.23 | $1,094.70 |