- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.34 / $784.00 / $2,575.00
| Facility | | $148.34 | $784.00 | $2,575.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $904.50 / $2,501.69 / $7,506.35
| Facility | 50 | $904.50 | $2,501.69 | $7,506.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.74 / $154.09 / $321.64
| Professional | | $137.74 | $154.09 | $321.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $238.92 / $280.54 / $600.75
| Professional | 50 | $238.92 | $280.54 | $600.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.46 / $732.46 / $805.71
| Facility | | $732.46 | $732.46 | $805.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.00 / $342.00 / $342.00
| Professional | | $342.00 | $342.00 | $342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.07 / $680.07 / $2,202.96
| Facility | | $680.07 | $680.07 | $2,202.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.78 / $225.46 / $341.37
| Professional | | $145.78 | $225.46 | $341.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,305.00 / $3,046.00
| Facility | | $610.00 | $1,305.00 | $3,046.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.66 / $201.67 / $397.93
| Professional | | $140.66 | $201.67 | $397.93 |