- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,691.53 / $8,511.38
| Facility | | $234.42 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $275.42 / $1,348.96 / $5,248.07
| Facility | 50 | $275.42 | $1,348.96 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $194.98 / $407.38
| Professional | | $131.83 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.09 / $323.59 / $1,000.00
| Professional | 50 | $229.09 | $323.59 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $8,709.64
| Facility | | $1,412.54 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $194.98 / $407.38
| Professional | | $131.83 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $288.40 / $562.34
| Professional | 50 | $199.53 | $288.40 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $489.78 / $1,659.59
| Facility | | $190.55 | $489.78 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $478.63
| Professional | | $131.83 | $234.42 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $338.84
| Professional | | $123.03 | $194.98 | $338.84 |