- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.01 / $1,473.20 / $3,363.00
| Facility | | $121.01 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $691.20 / $691.20 / $691.20
| Facility | 50 | $691.20 | $691.20 | $691.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $109.76 / $188.46
| Professional | | $58.40 | $109.76 | $188.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.16 / $1,177.70 / $7,161.00
| Facility | | $136.16 | $1,177.70 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.00 / $182.47 / $1,340.00
| Professional | | $72.00 | $182.47 | $1,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.52 / $86.76 / $154.88
| Facility | | $67.52 | $86.76 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.28 / $149.10 / $301.64
| Professional | | $85.28 | $149.10 | $301.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.81 / $145.06 / $279.20
| Professional | | $80.81 | $145.06 | $279.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.58 / $216.03 / $6,679.00
| Facility | | $68.58 | $216.03 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.24 / $137.22 / $189.43
| Professional | | $113.24 | $137.22 | $189.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.69 / $159.68 / $290.35
| Professional | | $75.69 | $159.68 | $290.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.23 / $1,049.26 / $1,673.98
| Facility | | $769.23 | $1,049.26 | $1,673.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.48 / $169.62 / $317.36
| Professional | | $46.48 | $169.62 | $317.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.37 / $2,078.00 / $12,000.00
| Facility | | $288.37 | $2,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $279.23 / $1,340.00
| Professional | | $123.43 | $279.23 | $1,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.29 / $215.26 / $339.90
| Professional | | $118.29 | $215.26 | $339.90 |