- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.40 / $1,458.50 / $9,095.00
| Facility | | $60.40 | $1,458.50 | $9,095.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $830.46 / $1,551.56 / $2,490.67
| Facility | 50 | $830.46 | $1,551.56 | $2,490.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.06 / $157.47 / $277.70
| Professional | | $61.06 | $157.47 | $277.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $340.36 / $1,902.37 / $1,902.37
| Professional | 50 | $340.36 | $1,902.37 | $1,902.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.00 / $215.39 / $347.40
| Professional | | $61.00 | $215.39 | $347.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $91.50 / $323.08 / $323.08
| Professional | 50 | $91.50 | $323.08 | $323.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $323.00 / $323.00
| Facility | | $323.00 | $323.00 | $323.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.14 / $160.07 / $367.37
| Professional | | $64.14 | $160.07 | $367.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.00 / $2,674.00 / $6,584.00
| Facility | | $1,135.00 | $2,674.00 | $6,584.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $196.79 / $258.12
| Professional | | $94.03 | $196.79 | $258.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.16 / $247.49 / $383.01
| Professional | | $162.16 | $247.49 | $383.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.00 / $1,950.00 / $5,107.00
| Facility | | $366.00 | $1,950.00 | $5,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.30 / $207.01 / $349.20
| Professional | | $144.30 | $207.01 | $349.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.06 / $176.94 / $176.94
| Professional | | $51.06 | $176.94 | $176.94 |