- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.41 / $3,390.52 / $7,504.64
| Facility | | $612.41 | $3,390.52 | $7,504.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.09 / $666.74 / $2,547.90
| Professional | | $525.09 | $666.74 | $2,547.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,023.26 / $6,631.62 / $14,092.16
| Facility | | $3,023.26 | $6,631.62 | $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
- $1,119.67 / $1,729.62 / $2,426.88
| Professional | | $1,119.67 | $1,729.62 | $2,426.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.03 / $2,188.19 / $5,264.02
| Facility | | $1,543.03 | $2,188.19 | $5,264.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.86 / $2,109.69 / $3,005.81
| Professional | | $1,252.86 | $2,109.69 | $3,005.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.36 / $2,000.54 / $4,144.89
| Facility | | $1,254.36 | $2,000.54 | $4,144.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.04 / $1,887.62 / $2,501.50
| Professional | | $1,103.04 | $1,887.62 | $2,501.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.44 / $2,585.00 / $7,734.42
| Facility | | $961.44 | $2,585.00 | $7,734.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.08 / $1,670.90 / $2,655.18
| Professional | | $869.08 | $1,670.90 | $2,655.18 |
- 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
- $869.08 / $1,666.53 / $2,578.38
| Professional | | $869.08 | $1,666.53 | $2,578.38 |