- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.00 / $1,715.80 / $3,363.00
| Facility | | $537.00 | $1,715.80 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.15 / $254.28 / $456.70
| Professional | | $120.15 | $254.28 | $456.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.25 / $288.25 / $288.25
| Professional | 50 | $288.25 | $288.25 | $288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.92 / $1,483.60 / $7,161.00
| Facility | | $303.92 | $1,483.60 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.38 / $417.61 / $1,892.59
| Professional | | $143.38 | $417.61 | $1,892.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.63 / $194.84 / $386.66
| Facility | | $151.63 | $194.84 | $386.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.20 / $436.28 / $842.90
| Professional | | $218.20 | $436.28 | $842.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.04 / $327.10 / $656.63
| Professional | | $170.04 | $327.10 | $656.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.80 / $300.00 / $6,679.00
| Facility | | $129.80 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.10 / $373.45 / $515.87
| Professional | | $306.10 | $373.45 | $515.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.59 / $356.84 / $779.53
| Professional | | $168.59 | $356.84 | $779.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.53 / $1,891.03 / $2,836.55
| Facility | | $945.53 | $1,891.03 | $2,836.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.29 / $268.29 / $268.29
| Professional | | $268.29 | $268.29 | $268.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.37 / $2,078.00 / $32,000.00
| Facility | | $649.37 | $2,078.00 | $32,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.41 / $608.23 / $2,049.86
| Professional | | $314.41 | $608.23 | $2,049.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.76 / $469.91 / $805.68
| Professional | | $297.76 | $469.91 | $805.68 |