- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.08 / $361.24 / $5,757.00
| Facility | | $159.08 | $361.24 | $5,757.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $225.45 / $345.20
| Professional | | $146.84 | $225.45 | $345.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,004.82 / $2,340.23 / $3,188.04
| Facility | | $2,004.82 | $2,340.23 | $3,188.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.35 / $252.11 / $311.58
| Professional | | $37.35 | $252.11 | $311.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $460.40 / $460.40 / $541.65
| Professional | 50 | $460.40 | $460.40 | $541.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.59 / $219.68 / $739.34
| Professional | | $122.59 | $219.68 | $739.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.82 / $361.24 / $5,757.00
| Facility | | $202.82 | $361.24 | $5,757.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.08 / $227.15 / $361.24
| Professional | | $159.08 | $227.15 | $361.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.59 / $204.94 / $292.83
| Professional | | $163.59 | $204.94 | $292.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.00 / $4,857.00 / $6,327.00
| Facility | | $1,527.00 | $4,857.00 | $6,327.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.02 / $320.17 / $934.59
| Professional | | $227.02 | $320.17 | $934.59 |