- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.18 / $1,367.00 / $3,940.00
| Facility | | $232.18 | $1,367.00 | $3,940.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $803.00 / $2,077.48 / $2,701.80
| Facility | 50 | $803.00 | $2,077.48 | $2,701.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.96 / $154.91 / $271.06
| Professional | | $82.96 | $154.91 | $271.06 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $62.22 / $293.92 / $695.27
| Professional | 50 | $62.22 | $293.92 | $695.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.23 / $106.23 / $212.60
| Professional | | $106.23 | $106.23 | $212.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $159.34 / $233.57 / $436.86
| Professional | 50 | $159.34 | $233.57 | $436.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,483.00 / $2,244.00
| Facility | | $764.00 | $1,483.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.90 / $175.83 / $305.27
| Professional | | $96.90 | $175.83 | $305.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.47 / $186.52 / $297.88
| Professional | | $101.47 | $186.52 | $297.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.29 / $452.96 / $30,000.00
| Facility | | $413.29 | $452.96 | $30,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $3,100.00 / $3,100.00
| Professional | | $776.25 | $3,100.00 | $3,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.00 / $1,465.00 / $2,886.00
| Facility | | $695.00 | $1,465.00 | $2,886.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.79 / $240.35 / $406.45
| Professional | | $154.79 | $240.35 | $406.45 |