- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.80 / $5,866.00 / $16,467.00
| Facility | | $746.80 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.72 / $716.80 / $748.20
| Professional | | $472.72 | $716.80 | $748.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,189.92 / $4,694.54 / $7,616.08
| Facility | | $2,189.92 | $4,694.54 | $7,616.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.00 / $571.70 / $980.60
| Professional | | $469.00 | $571.70 | $980.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,677.54
| Facility | | $505.00 | $505.00 | $1,677.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.69 / $725.69 / $1,412.44
| Professional | | $476.69 | $725.69 | $1,412.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.00 / $705.81 / $1,052.31
| Facility | | $522.00 | $705.81 | $1,052.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $783.00 / $949.50 / $1,578.47
| Facility | 50 | $783.00 | $949.50 | $1,578.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.00 / $660.00 / $1,376.31
| Professional | | $660.00 | $660.00 | $1,376.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,064.46 / $2,064.46 / $2,064.46
| Professional | 50 | $2,064.46 | $2,064.46 | $2,064.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.42 / $425.37 / $662.66
| Professional | | $69.42 | $425.37 | $662.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.93 / $616.04 / $1,013.32
| Professional | | $472.93 | $616.04 | $1,013.32 |