- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,570.88 / $10,232.93
| Facility | | $3,090.30 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $2,344.23 / $4,570.88
| Professional | | $165.96 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $1,862.09 / $4,677.35
| Professional | | $199.53 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $12,022.64
| Professional | | $32.36 | $33.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $22,387.21
| Facility | | $8,317.64 | $10,000.00 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | 50 | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $4,897.79
| Professional | | $223.87 | $354.81 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $2,238.72 / $4,365.16
| Professional | | $181.97 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $3,162.28 / $5,011.87
| Professional | | $218.78 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $2,238.72 / $5,248.07
| Professional | | $169.82 | $2,238.72 | $5,248.07 |