- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.52 / $2,472.00 / $5,923.00
| Facility | | $589.52 | $2,472.00 | $5,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.74 / $399.21 / $822.16
| Professional | | $284.74 | $399.21 | $822.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $254.18 / $254.18 / $254.18
| Professional | 50 | $254.18 | $254.18 | $254.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.26 / $340.75 / $454.13
| Professional | | $246.26 | $340.75 | $454.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $537.23 / $632.04 / $702.27
| Professional | 50 | $537.23 | $632.04 | $702.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.51 / $1,079.51 / $1,079.51
| Facility | | $1,079.51 | $1,079.51 | $1,079.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $421.53 / $771.00
| Professional | | $250.00 | $421.53 | $771.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.04 / $476.54 / $1,136.54
| Professional | | $248.04 | $476.54 | $1,136.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.34 / $2,578.34 / $2,578.34
| Facility | | $2,578.34 | $2,578.34 | $2,578.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.60 / $413.40 / $714.81
| Professional | | $275.60 | $413.40 | $714.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.00 / $2,940.00 / $7,138.00
| Facility | | $1,282.00 | $2,940.00 | $7,138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.60 / $468.30 / $842.33
| Professional | | $327.60 | $468.30 | $842.33 |