- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.25 / $1,310.45 / $2,825.00
| Facility | | $320.25 | $1,310.45 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,050.89 / $5,050.89 / $5,050.89
| Facility | 50 | $5,050.89 | $5,050.89 | $5,050.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.52 / $1,404.70 / $3,131.30
| Professional | | $281.52 | $1,404.70 | $3,131.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.82 / $190.25 / $350.69
| Professional | | $131.82 | $190.25 | $350.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,282.16 / $4,282.16 / $4,710.38
| Facility | | $4,282.16 | $4,282.16 | $4,710.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.00 / $743.00 / $743.00
| Professional | | $743.00 | $743.00 | $743.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.39 / $4,452.39 / $4,452.39
| Facility | | $4,452.39 | $4,452.39 | $4,452.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.86 / $1,088.57 / $2,848.39
| Professional | | $381.86 | $1,088.57 | $2,848.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $263.33
| Professional | | $32.34 | $32.34 | $263.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $3,445.00 / $8,411.00
| Facility | | $860.00 | $3,445.00 | $8,411.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.36 / $1,705.33 / $3,779.19
| Professional | | $1,365.36 | $1,705.33 | $3,779.19 |