- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.50 / $2,663.12 / $3,625.00
| Facility | | $320.50 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.03 / $294.20 / $502.10
| Professional | | $184.03 | $294.20 | $502.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.78 / $2,854.00 / $9,039.00
| Facility | | $454.78 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.41 / $448.76 / $1,326.24
| Professional | | $202.41 | $448.76 | $1,326.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.84 / $280.58 / $512.36
| Facility | | $215.84 | $280.58 | $512.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.61 / $479.49 / $864.14
| Professional | | $302.61 | $479.49 | $864.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $908.82 / $908.82 / $1,974.44
| Professional | 50 | $908.82 | $908.82 | $1,974.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.73 / $443.98 / $894.48
| Professional | | $190.73 | $443.98 | $894.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.36 / $393.56 / $6,679.00
| Facility | | $185.36 | $393.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.74 / $459.58 / $637.30
| Professional | | $362.74 | $459.58 | $637.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.82 / $489.71 / $1,041.48
| Professional | | $222.82 | $489.71 | $1,041.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.59 / $483.59 / $556.22
| Professional | | $483.59 | $483.59 | $556.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.16 / $3,764.00 / $16,394.00
| Facility | | $1,247.16 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.24 / $561.28 / $2,446.88
| Professional | | $348.24 | $561.28 | $2,446.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.43 / $469.84 / $1,021.21
| Professional | | $323.43 | $469.84 | $1,021.21 |