- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,365.16 / $8,511.38
| Facility | | $758.58 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $338.84 / $1,000.00
| Professional | | $107.15 | $338.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $588.84
| Professional | 50 | $575.44 | $575.44 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $37,153.52
| Facility | | $37,153.52 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $549.54 / $1,174.90
| Professional | | $177.83 | $549.54 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $812.83 / $1,698.24
| Professional | 50 | $263.03 | $812.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $331.13 / $1,445.44
| Professional | | $144.54 | $331.13 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $794.33 / $1,023.29
| Professional | | $263.03 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $776.25
| Professional | | $107.15 | $107.15 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $436.52 / $1,230.27
| Professional | | $114.82 | $436.52 | $1,230.27 |