- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,548.13 / $3,548.13
| Facility | | $263.03 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $2,818.38 / $4,677.35
| Professional | | $251.19 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $13,182.57 / $31,622.78
| Facility | | $1,778.28 | $13,182.57 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $16,218.10 / $29,512.09 / $74,131.02
| Facility | 50 | $16,218.10 | $29,512.09 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,621.81 / $9,772.37
| Professional | | $457.09 | $1,621.81 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $2,398.83 / $13,803.84
| Professional | 50 | $691.83 | $2,398.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $28,183.83
| Facility | | $7,413.10 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $4,897.79 / $12,882.50
| Professional | | $549.54 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $22,387.21
| Facility | | $9,120.11 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $4,570.88 / $11,481.54
| Professional | | $549.54 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $4,265.80 / $9,332.54
| Facility | | $338.84 | $4,265.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $20,892.96
| Professional | | $4,365.16 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,760.83 / $17,782.79
| Facility | | $1,584.89 | $6,760.83 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $3,467.37 / $11,481.54
| Professional | | $371.54 | $3,467.37 | $11,481.54 |