- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $796.12 / $796.12 / $796.12
| Facility | 50 | $796.12 | $796.12 | $796.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.19 / $456.89 / $1,151.33
| Professional | | $343.19 | $456.89 | $1,151.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.64 / $3,997.00 / $12,379.00
| Facility | | $1,091.64 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.35 / $874.40 / $3,360.96
| Professional | | $414.35 | $874.40 | $3,360.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.58 / $924.58 / $924.58
| Professional | | $924.58 | $924.58 | $924.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.16 / $1,022.85 / $1,854.21
| Professional | | $611.16 | $1,022.85 | $1,854.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.10 / $1,028.02 / $6,679.00
| Facility | | $469.10 | $1,028.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.29 / $680.20 / $1,120.07
| Professional | | $538.29 | $680.20 | $1,120.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.85 / $1,144.49 / $1,525.29
| Professional | | $573.85 | $1,144.49 | $1,525.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $16,394.00
| Facility | | $1,902.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.71 / $981.32 / $3,360.96
| Professional | | $501.71 | $981.32 | $3,360.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.96 / $719.61 / $1,490.84
| Professional | | $494.96 | $719.61 | $1,490.84 |