- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.12 / $3,212.12 / $10,632.00
| Facility | | $290.12 | $3,212.12 | $10,632.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.56 / $0.56 / $5,151.00
| Facility | 50 | $0.56 | $0.56 | $5,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.31 / $290.12 / $497.36
| Professional | | $164.31 | $290.12 | $497.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.04 / $114.04 / $622.69
| Professional | 50 | $114.04 | $114.04 | $622.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.77 / $183.32 / $285.11
| Professional | | $179.77 | $183.32 | $285.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $1,022.68 / $1,217.48
| Facility | | $432.00 | $1,022.68 | $1,217.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.98 / $343.03 / $677.92
| Professional | | $184.98 | $343.03 | $677.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.00 / $5,731.00 / $11,037.00
| Facility | | $3,105.00 | $5,731.00 | $11,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.44 / $269.89 / $444.26
| Professional | | $179.44 | $269.89 | $444.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.91 / $301.97 / $520.20
| Professional | | $34.91 | $301.97 | $520.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.00 / $5,811.00 / $10,057.00
| Facility | | $1,681.00 | $5,811.00 | $10,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.93 / $391.88 / $713.74
| Professional | | $283.93 | $391.88 | $713.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.02 / $280.35 / $280.35
| Professional | | $169.02 | $280.35 | $280.35 |