- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $1,412.54
| Professional | | $416.87 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $208.93 / $724.44
| Professional | 50 | $208.93 | $208.93 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $977.24
| Professional | | $707.95 | $707.95 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,000.00
| Professional | | $457.09 | $616.60 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,148.15
| Facility | | $776.25 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,148.15
| Professional | | $776.25 | $977.24 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,096.48
| Facility | | $501.19 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $616.60 / $1,000.00
| Professional | | $79.43 | $616.60 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,148.15
| Professional | | $707.95 | $891.25 | $1,148.15 |