- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.44 / $2,278.50 / $7,937.24
| Facility | | $391.44 | $2,278.50 | $7,937.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.10 / $496.39 / $1,864.17
| Professional | | $355.10 | $496.39 | $1,864.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.23 / $6,669.88 / $14,092.16
| Facility | | $2,445.23 | $6,669.88 | $14,092.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,691.53 / $13,186.96 / $23,122.16
| Facility | 50 | $8,691.53 | $13,186.96 | $23,122.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.41 / $1,224.50 / $1,845.29
| Professional | | $769.41 | $1,224.50 | $1,845.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.82 / $1,780.90 / $4,284.20
| Facility | | $1,255.82 | $1,780.90 | $4,284.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.95 / $1,571.09 / $2,187.89
| Professional | | $895.95 | $1,571.09 | $2,187.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.89 / $1,628.17 / $3,373.39
| Facility | | $1,020.89 | $1,628.17 | $3,373.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.83 / $1,263.32 / $2,024.39
| Professional | | $789.83 | $1,263.32 | $2,024.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.42 / $918.99 / $5,879.00
| Facility | | $494.42 | $918.99 | $5,879.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,503.25 / $3,503.25 / $9,053.86
| Facility | 50 | $3,503.25 | $3,503.25 | $9,053.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.37 / $1,370.85 / $3,060.32
| Professional | | $667.37 | $1,370.85 | $3,060.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.37 / $1,187.74 / $1,989.06
| Professional | | $667.37 | $1,187.74 | $1,989.06 |