- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.08 / $2,279.90 / $7,761.00
| Facility | | $287.08 | $2,279.90 | $7,761.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,695.97 / $6,115.80 / $12,013.44
| Facility | 50 | $2,695.97 | $6,115.80 | $12,013.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.61 / $230.03 / $322.49
| Professional | | $149.61 | $230.03 | $322.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $120.58 / $234.14 / $448.84
| Professional | 50 | $120.58 | $234.14 | $448.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $266.89 / $297.98
| Professional | | $218.03 | $266.89 | $297.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.15 / $282.89 / $362.10
| Facility | | $186.15 | $282.89 | $362.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.85 / $260.33 / $313.76
| Professional | | $258.85 | $260.33 | $313.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $223.57 / $281.27
| Professional | | $32.34 | $223.57 | $281.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,749.17 / $3,749.50 / $4,629.45
| Facility | | $2,749.17 | $3,749.50 | $4,629.45 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,936.62 / $5,624.25 / $7,205.67
| Facility | 50 | $3,936.62 | $5,624.25 | $7,205.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.57 / $247.57 / $260.33
| Professional | | $247.57 | $247.57 | $260.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,450.00 / $6,124.00 / $7,609.00
| Facility | | $3,450.00 | $6,124.00 | $7,609.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.68 / $238.62 / $331.15
| Professional | | $161.68 | $238.62 | $331.15 |