- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,000.00 / $9,549.93
| Facility | | $223.87 | $1,000.00 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $660.69
| Professional | | $173.78 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $467.74 / $1,230.27 / $1,230.27
| Professional | 50 | $467.74 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,762.47 / $12,302.69
| Facility | | $2,344.23 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $288.40 / $389.05
| Professional | | $194.98 | $288.40 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $501.19
| Professional | | $218.78 | $331.13 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $363.08
| Professional | | $32.36 | $33.11 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $588.84
| Facility | | $208.93 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $501.19
| Professional | | $218.78 | $331.13 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,265.80 / $7,762.47
| Facility | | $562.34 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $524.81
| Professional | | $218.78 | $331.13 | $524.81 |