- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.70 / $2,382.00 / $9,133.00
| Facility | | $453.70 | $2,382.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,699.98 / $3,141.14 / $4,860.83
| Facility | 50 | $1,699.98 | $3,141.14 | $4,860.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.76 / $378.62 / $722.12
| Professional | | $189.76 | $378.62 | $722.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $502.37 / $627.44 / $627.44
| Professional | 50 | $502.37 | $627.44 | $627.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.44 / $163.44 / $163.44
| Professional | | $163.44 | $163.44 | $163.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $303.19 / $303.19 / $303.19
| Professional | 50 | $303.19 | $303.19 | $303.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.10 / $366.00 / $719.04
| Professional | | $311.10 | $366.00 | $719.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.26 / $419.94 / $722.15
| Professional | | $226.26 | $419.94 | $722.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.76 / $573.78 / $3,595.00
| Facility | | $189.76 | $573.78 | $3,595.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.01 / $597.90 / $3,287.44
| Professional | | $439.01 | $597.90 | $3,287.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.66 / $534.38 / $776.63
| Professional | | $425.66 | $534.38 | $776.63 |