- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.13 / $1,865.44 / $4,828.00
| Facility | | $162.13 | $1,865.44 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.83 / $1,808.85 / $2,462.67
| Professional | | $158.83 | $1,808.85 | $2,462.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.31 / $10,959.17 / $24,323.22
| Facility | | $1,685.31 | $10,959.17 | $24,323.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,606.43 / $23,678.36 / $41,517.91
| Facility | 50 | $15,606.43 | $23,678.36 | $41,517.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.54 / $942.00 / $5,608.74
| Professional | | $298.54 | $942.00 | $5,608.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $439.68 / $2,062.91 / $8,413.11
| Professional | 50 | $439.68 | $2,062.91 | $8,413.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.47 / $5,993.67 / $14,418.60
| Facility | | $4,226.47 | $5,993.67 | $14,418.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.24 / $1,065.94 / $6,888.68
| Professional | | $372.24 | $1,065.94 | $6,888.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,435.82 / $5,479.66 / $11,353.23
| Facility | | $3,435.82 | $5,479.66 | $11,353.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.10 / $1,055.39 / $5,985.00
| Professional | | $328.10 | $1,055.39 | $5,985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.88 / $2,728.46 / $6,927.00
| Facility | | $255.88 | $2,728.46 | $6,927.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,910.17 / $5,386.64 / $10,359.84
| Professional | | $2,910.17 | $5,386.64 | $10,359.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.46 / $4,096.62 / $7,819.39
| Professional | | $2,125.46 | $4,096.62 | $7,819.39 |