- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.11 / $2,663.12 / $3,693.00
| Facility | | $413.11 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.60 / $413.11 / $909.57
| Professional | | $142.60 | $413.11 | $909.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,797.20 / $2,797.20 / $2,797.20
| Professional | 50 | $2,797.20 | $2,797.20 | $2,797.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $3,715.00 / $6,490.90
| Facility | | $443.91 | $3,715.00 | $6,490.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.38 / $772.35 / $2,202.41
| Professional | | $199.38 | $772.35 | $2,202.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.32 / $272.12 / $533.77
| Facility | | $209.32 | $272.12 | $533.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.26 / $343.26 / $1,030.66
| Professional | | $343.26 | $343.26 | $1,030.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.50 / $721.01 / $1,521.31
| Professional | | $285.50 | $721.01 | $1,521.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.30 / $286.26 / $6,679.00
| Facility | | $178.30 | $286.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.29 / $749.69 / $1,340.40
| Professional | | $593.29 | $749.69 | $1,340.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.97 / $626.69 / $1,391.31
| Professional | | $227.97 | $626.69 | $1,391.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.06 / $1,270.07 / $3,661.36
| Professional | | $685.06 | $1,270.07 | $3,661.36 |
- 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
- $652.74 / $846.09 / $1,695.78
| Professional | | $652.74 | $846.09 | $1,695.78 |