- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.99 / $1,377.78 / $2,525.00
| Facility | | $285.99 | $1,377.78 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.99 / $1,261.43 / $1,866.02
| Professional | | $285.99 | $1,261.43 | $1,866.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.00 / $7,195.80 / $11,327.71
| Facility | | $3,630.00 | $7,195.80 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,268.16 / $11,027.38 / $19,335.54
| Facility | 50 | $7,268.16 | $11,027.38 | $19,335.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.23 / $1,683.84 / $4,154.50
| Professional | | $585.23 | $1,683.84 | $4,154.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $865.34 / $2,306.71 / $6,231.75
| Professional | 50 | $865.34 | $2,306.71 | $6,231.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.87 / $4,341.77 / $10,444.71
| Facility | | $2,781.87 | $4,341.77 | $10,444.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.91 / $1,308.33 / $4,529.92
| Professional | | $425.91 | $1,308.33 | $4,529.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,410.73 / $3,828.02 / $8,224.19
| Facility | | $2,410.73 | $3,828.02 | $8,224.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.16 / $1,776.14 / $4,085.34
| Professional | | $552.16 | $1,776.14 | $4,085.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.83 / $1,310.25 / $3,245.67
| Facility | | $355.83 | $1,310.25 | $3,245.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.84 / $2,631.28 / $5,555.51
| Professional | | $1,342.84 | $2,631.28 | $5,555.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.99 / $2,265.66 / $4,626.43
| Professional | | $1,282.99 | $2,265.66 | $4,626.43 |