- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.55 / $2,260.00 / $5,506.00
| Facility | | $478.55 | $2,260.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $910.16 / $910.16 / $910.16
| Facility | 50 | $910.16 | $910.16 | $910.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.69 / $207.71 / $434.43
| Professional | | $117.69 | $207.71 | $434.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,212.03 / $1,212.03 / $1,212.03
| Professional | 50 | $1,212.03 | $1,212.03 | $1,212.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.71 / $1,516.10 / $2,479.76
| Facility | | $402.71 | $1,516.10 | $2,479.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.07 / $122.29 / $197.35
| Professional | | $85.07 | $122.29 | $197.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.32 / $213.44 / $342.68
| Professional | | $118.32 | $213.44 | $342.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.33 / $238.57 / $1,371.00
| Facility | | $116.33 | $238.57 | $1,371.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.82 / $267.89 / $1,848.32
| Professional | | $190.82 | $267.89 | $1,848.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $2,017.00 / $3,268.00
| Facility | | $1,086.00 | $2,017.00 | $3,268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $234.72 / $483.84
| Professional | | $159.18 | $234.72 | $483.84 |