- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.66 / $4,261.00 / $12,154.00
| Facility | | $729.66 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,030.37 / $2,030.37 / $2,030.37
| Facility | 50 | $2,030.37 | $2,030.37 | $2,030.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.81 / $543.76 / $786.35
| Professional | | $393.81 | $543.76 | $786.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.14 / $579.14 / $579.14
| Professional | | $579.14 | $579.14 | $579.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.00 / $548.69 / $763.60
| Professional | | $411.00 | $548.69 | $763.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $616.50 / $823.03 / $1,145.40
| Professional | 50 | $616.50 | $823.03 | $1,145.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $730.00 / $1,135.71
| Facility | | $730.00 | $730.00 | $1,135.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.40 / $654.54 / $1,362.29
| Professional | | $417.40 | $654.54 | $1,362.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.67 / $1,325.00 / $26,542.00
| Facility | | $521.67 | $1,325.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.03 / $835.30 / $4,830.56
| Professional | | $547.03 | $835.30 | $4,830.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.60 / $725.30 / $1,214.69
| Professional | | $533.60 | $725.30 | $1,214.69 |