- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.66 / $1,850.61 / $4,828.00
| Facility | | $147.66 | $1,850.61 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $1,561.09 / $3,363.78
| Professional | | $147.66 | $1,561.09 | $3,363.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.26 / $10,959.17 / $24,323.22
| Facility | | $283.26 | $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
- $272.45 / $860.00 / $5,559.82
| Professional | | $272.45 | $860.00 | $5,559.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $400.73 / $2,044.05 / $8,339.73
| Professional | 50 | $400.73 | $2,044.05 | $8,339.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,191.10 / $5,943.51 / $14,297.91
| Facility | | $4,191.10 | $5,943.51 | $14,297.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.24 / $971.40 / $6,829.69
| Professional | | $336.24 | $971.40 | $6,829.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,407.07 / $5,433.79 / $11,258.20
| Facility | | $3,407.07 | $5,433.79 | $11,258.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.00 / $1,505.75 / $5,933.75
| Professional | | $299.00 | $1,505.75 | $5,933.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.40 / $2,704.27 / $6,740.00
| Facility | | $241.40 | $2,704.27 | $6,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,971.47 / $5,528.86 / $10,966.34
| Professional | | $2,971.47 | $5,528.86 | $10,966.34 |
- 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
- $2,358.32 / $4,784.18 / $8,087.32
| Professional | | $2,358.32 | $4,784.18 | $8,087.32 |