- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.01 / $2,747.00 / $6,075.00
| Facility | | $171.01 | $2,747.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.62 / $225.45 / $900.00
| Professional | | $115.62 | $225.45 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $474.95 / $474.95 / $474.95
| Professional | 50 | $474.95 | $474.95 | $474.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.26 / $2,411.51 / $10,821.00
| Facility | | $302.26 | $2,411.51 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.04 / $467.70 / $6,427.75
| Professional | | $157.04 | $467.70 | $6,427.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.81 / $188.25 / $352.80
| Facility | | $144.81 | $188.25 | $352.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.37 / $237.47 / $448.50
| Professional | | $137.37 | $237.47 | $448.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.51 / $375.89 / $781.12
| Professional | | $197.51 | $375.89 | $781.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.75 / $300.00 / $6,679.00
| Facility | | $125.75 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.79 / $329.54 / $589.20
| Professional | | $260.79 | $329.54 | $589.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.44 / $339.12 / $616.54
| Professional | | $157.44 | $339.12 | $616.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,856.16 / $1,856.16 / $2,175.17
| Facility | | $1,856.16 | $1,856.16 | $2,175.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.12 / $384.12 / $419.64
| Professional | | $353.12 | $384.12 | $419.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.54 / $3,649.00 / $26,542.00
| Facility | | $852.54 | $3,649.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.58 / $841.57 / $6,427.75
| Professional | | $299.58 | $841.57 | $6,427.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.45 / $498.68 / $942.76
| Professional | | $283.45 | $498.68 | $942.76 |