- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.45 / $4,241.22 / $13,841.56
| Facility | | $225.45 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.39 / $618.54 / $1,976.00
| Professional | | $200.39 | $618.54 | $1,976.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $639.87 / $639.87 / $639.87
| Professional | 50 | $639.87 | $639.87 | $639.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.29 / $400.05 / $528.69
| Professional | | $241.29 | $400.05 | $528.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.02 / $5,453.87 / $10,634.64
| Facility | | $4,180.02 | $5,453.87 | $10,634.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.44 / $353.17 / $473.74
| Professional | | $208.44 | $353.17 | $473.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.86 / $217.86 / $217.86
| Facility | | $217.86 | $217.86 | $217.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.95 / $560.16 / $745.50
| Professional | | $454.95 | $560.16 | $745.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.45 / $752.38 / $1,775.00
| Facility | | $225.45 | $752.38 | $1,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.31 / $840.18 / $1,444.94
| Professional | | $433.31 | $840.18 | $1,444.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $865.40 / $865.40 / $865.40
| Professional | 50 | $865.40 | $865.40 | $865.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.74 / $562.09 / $1,153.65
| Facility | | $244.74 | $562.09 | $1,153.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.20 / $791.39 / $1,229.72
| Professional | | $477.20 | $791.39 | $1,229.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.34 / $975.49 / $1,400.70
| Professional | | $582.34 | $975.49 | $1,400.70 |