- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.58 / $6,919.00 / $15,908.00
| Facility | | $186.58 | $6,919.00 | $15,908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.34 / $448.26 / $923.46
| Professional | | $135.34 | $448.26 | $923.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.58 / $456.57 / $1,730.17
| Professional | | $253.58 | $456.57 | $1,730.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.63 / $235.63 / $235.63
| Facility | | $235.63 | $235.63 | $235.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.69 / $456.13 / $1,518.68
| Professional | | $179.69 | $456.13 | $1,518.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.87 / $500.28 / $1,183.30
| Facility | | $148.87 | $500.28 | $1,183.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $375.00 / $607.50 / $1,950.71
| Facility | 50 | $375.00 | $607.50 | $1,950.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.00 / $703.00 / $815.49
| Professional | | $703.00 | $703.00 | $815.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.70 / $777.20 / $1,416.40
| Professional | | $208.70 | $777.20 | $1,416.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.00 / $874.00 / $2,074.00
| Facility | | $116.00 | $874.00 | $2,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.79 / $867.40 / $1,539.20
| Professional | | $568.79 | $867.40 | $1,539.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,053.11 / $1,053.11
| Facility | | $55.00 | $1,053.11 | $1,053.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.42 / $4,175.33 / $4,773.38
| Professional | | $2,138.42 | $4,175.33 | $4,773.38 |