- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,850.00 / $3,884.00
| Facility | | $443.91 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,551.98 / $1,551.98 / $7,890.05
| Facility | 50 | $1,551.98 | $1,551.98 | $7,890.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.77 / $173.64 / $270.06
| Professional | | $140.77 | $173.64 | $270.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,935.93 / $3,836.43 / $5,836.30
| Facility | | $1,935.93 | $3,836.43 | $5,836.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $173.86 / $247.41
| Professional | | $149.63 | $173.86 | $247.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.49 / $190.80 / $271.26
| Professional | | $143.49 | $190.80 | $271.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,752.00 / $6,544.00
| Facility | | $500.00 | $1,752.00 | $6,544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.97 / $176.06 / $318.01
| Professional | | $123.97 | $176.06 | $318.01 |