- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.13 / $2,537.00 / $4,410.00
| Facility | | $483.13 | $2,537.00 | $4,410.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $584.10 / $879.04 / $933.15
| Facility | 50 | $584.10 | $879.04 | $933.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $210.57 / $560.23
| Professional | | $115.14 | $210.57 | $560.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $296.75 / $840.35 / $1,582.50
| Professional | 50 | $296.75 | $840.35 | $1,582.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.98 / $953.00 / $2,733.00
| Facility | | $302.98 | $953.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.03 / $353.32 / $1,447.92
| Professional | | $151.03 | $353.32 | $1,447.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.15 / $208.20 / $367.38
| Facility | | $160.15 | $208.20 | $367.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.63 / $262.63 / $402.61
| Professional | | $262.63 | $262.63 | $402.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.97 / $375.89 / $603.50
| Professional | | $201.97 | $375.89 | $603.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.87 / $219.02 / $6,679.00
| Facility | | $136.87 | $219.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.14 / $294.60 / $526.72
| Professional | | $233.14 | $294.60 | $526.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.20 / $364.44 / $549.25
| Professional | | $169.20 | $364.44 | $549.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.80 / $981.38 / $1,319.04
| Facility | | $807.80 | $981.38 | $1,319.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.85 / $494.85 / $617.29
| Professional | | $421.85 | $494.85 | $617.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.72 / $545.33 / $1,447.92
| Professional | | $221.72 | $545.33 | $1,447.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.09 / $313.36 / $693.34
| Professional | | $214.09 | $313.36 | $693.34 |