- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $1,479.11
| Facility | | $56.23 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $1,122.02 / $2,187.76
| Professional | | $56.23 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,862.09 / $4,466.84
| Facility | | $323.59 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $275.42 / $3,890.45
| Professional | | $74.13 | $275.42 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $407.38 / $5,623.41
| Professional | 50 | $109.65 | $407.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,168.69 / $10,000.00
| Facility | | $2,884.03 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $912.01 / $5,495.41
| Professional | | $97.72 | $912.01 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,981.07 / $7,943.28
| Facility | | $3,235.94 | $3,981.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $1,905.46 / $4,897.79
| Professional | | $95.50 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $1,513.56 / $3,548.13
| Facility | | $64.57 | $1,513.56 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,511.89 / $5,495.41
| Professional | | $1,288.25 | $2,511.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $6,760.83
| Facility | | $1,584.89 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $1,230.27 / $3,890.45
| Professional | | $69.18 | $1,230.27 | $3,890.45 |