- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $1,273.00 / $3,779.00
| Facility | | $379.00 | $1,273.00 | $3,779.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $975.00 / $3,832.50 / $6,162.93
| Facility | 50 | $975.00 | $3,832.50 | $6,162.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.13 / $401.83 / $683.51
| Professional | | $210.13 | $401.83 | $683.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $345.12 / $345.12 / $345.12
| Professional | 50 | $345.12 | $345.12 | $345.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.97 / $398.97 / $398.97
| Professional | | $398.97 | $398.97 | $398.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $275.45 / $275.45 / $275.45
| Professional | 50 | $275.45 | $275.45 | $275.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.10 / $2,231.19 / $4,054.40
| Facility | | $976.10 | $2,231.19 | $4,054.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.24 / $417.22 / $679.78
| Professional | | $235.24 | $417.22 | $679.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.78 / $1,391.46 / $1,391.46
| Facility | | $169.78 | $1,391.46 | $1,391.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.92 / $385.74 / $686.70
| Professional | | $204.92 | $385.74 | $686.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,420.00 / $7,085.00
| Facility | | $746.00 | $2,420.00 | $7,085.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.48 / $495.55 / $862.73
| Professional | | $360.48 | $495.55 | $862.73 |