- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $2,967.00 / $10,651.00
| Facility | | $92.60 | $2,967.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,551.00 / $4,551.00 / $17,087.52
| Facility | 50 | $4,551.00 | $4,551.00 | $17,087.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,971.00 / $7,022.00
| Facility | | $1,974.00 | $2,971.00 | $7,022.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.36 / $871.36 / $2,744.83
| Facility | | $871.36 | $871.36 | $2,744.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.98 / $101.28 / $207.09
| Facility | | $68.98 | $101.28 | $207.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.36 / $101.75 / $153.32
| Professional | | $77.36 | $101.75 | $153.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.00 / $2,537.00 / $3,681.00
| Facility | | $1,361.00 | $2,537.00 | $3,681.00 |