- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $4,005.00 / $7,960.15
| Facility | | $936.00 | $4,005.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,075.55 / $2,248.50 / $3,297.00
| Facility | 50 | $2,075.55 | $2,248.50 | $3,297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.37 / $324.35 / $793.85
| Professional | | $242.37 | $324.35 | $793.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $124.76 / $1,215.00 / $1,849.31
| Professional | 50 | $124.76 | $1,215.00 | $1,849.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.86 / $269.62 / $404.42
| Professional | | $198.86 | $269.62 | $404.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,469.03 / $4,469.03 / $4,469.03
| Facility | | $4,469.03 | $4,469.03 | $4,469.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.54 / $410.33 / $757.92
| Professional | | $247.54 | $410.33 | $757.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.26 / $456.32 / $3,658.00
| Facility | | $265.26 | $456.32 | $3,658.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,920.56 / $1,920.56 / $2,463.86
| Facility | 50 | $1,920.56 | $1,920.56 | $2,463.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.45 / $443.63 / $4,486.05
| Professional | | $261.45 | $443.63 | $4,486.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.00 / $3,533.00 / $5,838.00
| Facility | | $2,381.00 | $3,533.00 | $5,838.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.56 / $395.67 / $845.35
| Professional | | $249.56 | $395.67 | $845.35 |