- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.73 / $2,118.00 / $8,160.30
| Facility | | $490.73 | $2,118.00 | $8,160.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.49 / $958.67 / $2,063.79
| Professional | | $307.49 | $958.67 | $2,063.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,804.48 / $2,804.48 / $2,804.48
| Professional | 50 | $2,804.48 | $2,804.48 | $2,804.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.73 / $408.20 / $965.18
| Professional | | $347.73 | $408.20 | $965.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,171.78 / $4,610.67 / $8,321.28
| Facility | | $2,171.78 | $4,610.67 | $8,321.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.18 / $991.48 / $2,301.71
| Professional | | $347.18 | $991.48 | $2,301.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $709.00 / $735.00
| Facility | | $709.00 | $709.00 | $735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.61 / $924.43 / $2,373.06
| Professional | | $332.61 | $924.43 | $2,373.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.84 / $1,295.27 / $4,053.27
| Professional | | $362.84 | $1,295.27 | $4,053.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.60 / $354.42 / $1,254.73
| Professional | | $310.60 | $354.42 | $1,254.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,418.81
| Professional | | $32.34 | $32.34 | $1,418.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.00 / $4,391.00 / $8,566.00
| Facility | | $1,600.00 | $4,391.00 | $8,566.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.07 / $1,891.17 / $2,827.03
| Professional | | $1,092.07 | $1,891.17 | $2,827.03 |