- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,079.00 / $3,625.00
| Facility | | $988.00 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.90 / $1,231.55 / $2,358.56
| Professional | | $67.90 | $1,231.55 | $2,358.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.27 / $1,798.55 / $4,689.00
| Facility | | $116.27 | $1,798.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.06 / $1,542.01 / $4,623.85
| Professional | | $47.06 | $1,542.01 | $4,623.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.16 / $65.20 / $128.16
| Facility | | $50.16 | $65.20 | $128.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.18 / $586.22 / $3,180.59
| Professional | | $72.18 | $586.22 | $3,180.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $538.67 / $538.67 / $879.33
| Professional | 50 | $538.67 | $538.67 | $879.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.34 / $1,230.45 / $3,510.49
| Professional | | $67.34 | $1,230.45 | $3,510.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.70 / $168.26 / $6,679.00
| Facility | | $51.70 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.73 / $1,806.35 / $2,556.88
| Professional | | $1,425.73 | $1,806.35 | $2,556.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.25 / $1,541.73 / $3,414.93
| Professional | | $53.25 | $1,541.73 | $3,414.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.25 / $1,710.34 / $2,435.63
| Professional | | $1,290.25 | $1,710.34 | $2,435.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.07 / $2,213.58 / $8,992.87
| Professional | | $1,448.07 | $2,213.58 | $8,992.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.81 / $2,105.67 / $4,491.01
| Professional | | $1,393.81 | $2,105.67 | $4,491.01 |