- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.78 / $2,510.78 / $10,086.00
| Facility | | $197.78 | $2,510.78 | $10,086.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,145.26 / $4,145.26 / $7,891.57
| Facility | 50 | $4,145.26 | $4,145.26 | $7,891.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.94 / $197.78 / $316.39
| Professional | | $113.94 | $197.78 | $316.39 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $399.32 / $556.23 / $556.23
| Professional | 50 | $399.32 | $556.23 | $556.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.31 / $287.17 / $373.26
| Professional | | $118.31 | $287.17 | $373.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.46 / $177.46 / $358.52
| Professional | 50 | $177.46 | $177.46 | $358.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $476.39 / $567.14
| Facility | | $323.00 | $476.39 | $567.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.85 / $234.96 / $439.59
| Professional | | $122.85 | $234.96 | $439.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $3,148.00 / $7,541.00
| Facility | | $2,093.00 | $3,148.00 | $7,541.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.95 / $236.40 / $289.33
| Professional | | $119.95 | $236.40 | $289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.37 / $248.71 / $386.31
| Professional | | $173.37 | $248.71 | $386.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.00 / $2,671.00 / $6,077.00
| Facility | | $591.00 | $2,671.00 | $6,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.41 / $267.99 / $467.79
| Professional | | $183.41 | $267.99 | $467.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.09 / $202.22 / $202.22
| Professional | | $100.09 | $202.22 | $202.22 |