- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $3,745.00 / $7,283.00
| Facility | | $936.00 | $3,745.00 | $7,283.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,838.75 / $2,838.75 / $3,942.00
| Facility | 50 | $2,838.75 | $2,838.75 | $3,942.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.97 / $532.26 / $1,247.75
| Professional | | $300.97 | $532.26 | $1,247.75 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $145.43 / $224.63 / $760.80
| Professional | 52 | $145.43 | $224.63 | $760.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.80 / $325.95 / $373.15
| Professional | | $275.80 | $325.95 | $373.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,822.29 / $4,140.09
| Facility | | $688.17 | $2,822.29 | $4,140.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.63 / $501.16 / $674.96
| Professional | | $417.63 | $501.16 | $674.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.56 / $382.56 / $382.56
| Facility | | $382.56 | $382.56 | $382.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.45 / $488.68 / $978.11
| Professional | | $303.45 | $488.68 | $978.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.85 / $542.21 / $5,687.83
| Facility | | $290.85 | $542.21 | $5,687.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.44 / $601.66 / $3,589.98
| Professional | | $418.44 | $601.66 | $3,589.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,336.00 / $4,635.00 / $7,217.00
| Facility | | $3,336.00 | $4,635.00 | $7,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.32 / $570.61 / $846.02
| Professional | | $397.32 | $570.61 | $846.02 |