- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,015.89 / $8,965.00
| Facility | | $100.00 | $1,015.89 | $8,965.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.74 / $240.41 / $394.82
| Professional | | $131.74 | $240.41 | $394.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $556.23 / $556.23 / $556.23
| Professional | 50 | $556.23 | $556.23 | $556.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.67 / $127.67 / $127.67
| Professional | | $127.67 | $127.67 | $127.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,359.00 / $3,300.00
| Facility | | $1,223.09 | $1,359.00 | $3,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.27 / $219.34 / $336.96
| Professional | | $127.27 | $219.34 | $336.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.20 / $327.52 / $480.58
| Professional | 50 | $190.20 | $327.52 | $480.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.83 / $1,306.21 / $1,351.93
| Facility | | $221.83 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.51 / $343.41 / $655.29
| Professional | | $181.51 | $343.41 | $655.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.46 / $324.39 / $728.24
| Professional | | $158.46 | $324.39 | $728.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,035.00 / $8,035.00 / $8,035.00
| Facility | | $8,035.00 | $8,035.00 | $8,035.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.45 / $430.53 / $738.02
| Professional | | $274.45 | $430.53 | $738.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.30 / $207.53 / $313.70
| Professional | | $108.30 | $207.53 | $313.70 |