- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.11 / $1,891.86 / $4,828.00
| Facility | | $184.11 | $1,891.86 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,624.51 / $6,624.51 / $7,273.64
| Facility | 50 | $6,624.51 | $6,624.51 | $7,273.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.11 / $454.93 / $3,831.30
| Professional | | $184.11 | $454.93 | $3,831.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $193.78 / $934.25 / $1,401.37
| Professional | 50 | $193.78 | $934.25 | $1,401.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.76 / $10,959.17 / $24,323.22
| Facility | | $1,522.76 | $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
- $339.92 / $1,070.00 / $5,694.08
| Professional | | $339.92 | $1,070.00 | $5,694.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.83 / $1,605.00 / $8,541.12
| Professional | 50 | $501.83 | $1,605.00 | $8,541.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,286.28 / $6,078.48 / $14,622.61
| Facility | | $4,286.28 | $6,078.48 | $14,622.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.23 / $1,212.48 / $6,995.14
| Professional | | $423.23 | $1,212.48 | $6,995.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,484.44 / $5,557.19 / $11,513.86
| Facility | | $3,484.44 | $5,557.19 | $11,513.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.21 / $1,200.47 / $6,077.50
| Professional | | $373.21 | $1,200.47 | $6,077.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.77 / $2,772.20 / $6,927.00
| Facility | | $301.77 | $2,772.20 | $6,927.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,035.80 / $5,600.98 / $11,062.39
| Professional | | $3,035.80 | $5,600.98 | $11,062.39 |
- 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
- $1,998.85 / $4,887.04 / $7,920.16
| Professional | | $1,998.85 | $4,887.04 | $7,920.16 |