- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.87 / $927.00 / $2,250.00
| Facility | | $200.87 | $927.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,174.23 / $1,174.23 / $1,318.86
| Facility | 50 | $1,174.23 | $1,174.23 | $1,318.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.23 / $200.87 / $402.85
| Professional | | $113.23 | $200.87 | $402.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.59 / $1,382.00 / $1,859.23
| Facility | | $1,141.59 | $1,382.00 | $1,859.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,712.40 / $2,072.98 / $2,788.84
| Facility | 50 | $1,712.40 | $2,072.98 | $2,788.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.38 / $271.56 / $409.20
| Professional | | $150.38 | $271.56 | $409.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.13 / $242.10 / $473.43
| Professional | | $139.13 | $242.10 | $473.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,234.00 / $2,481.00
| Facility | | $375.00 | $1,234.00 | $2,481.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.27 / $243.67 / $482.62
| Professional | | $191.27 | $243.67 | $482.62 |