- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.27 / $505.27 / $2,525.00
| Facility | | $505.27 | $505.27 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.66 / $505.27 / $692.53
| Professional | | $403.66 | $505.27 | $692.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.94 / $5,601.46 / $11,441.84
| Facility | | $1,998.94 | $5,601.46 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,341.39 / $11,138.50 / $19,530.37
| Facility | 50 | $7,341.39 | $11,138.50 | $19,530.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.94 / $1,224.54 / $1,718.17
| Professional | | $783.94 | $1,224.54 | $1,718.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.90 / $1,659.07 / $3,991.12
| Facility | | $1,169.90 | $1,659.07 | $3,991.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.44 / $1,596.86 / $2,249.06
| Professional | | $937.44 | $1,596.86 | $2,249.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.05 / $1,516.79 / $3,142.61
| Facility | | $951.05 | $1,516.79 | $3,142.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.33 / $1,412.39 / $1,871.72
| Professional | | $825.33 | $1,412.39 | $1,871.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.73 / $900.41 / $7,770.00
| Facility | | $541.73 | $900.41 | $7,770.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.09 / $1,167.09 / $2,509.66
| Professional | | $582.09 | $1,167.09 | $2,509.66 |
- 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
- $599.04 / $1,167.09 / $1,884.63
| Professional | | $599.04 | $1,167.09 | $1,884.63 |