- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.11 / $3,513.56 / $6,575.00
| Facility | | $262.11 | $3,513.56 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.71 / $1,992.00 / $4,634.74
| Professional | | $249.71 | $1,992.00 | $4,634.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $5,896.19 / $5,896.19 / $5,896.19
| Professional | 50 | $5,896.19 | $5,896.19 | $5,896.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.94 / $10,959.17 / $24,323.22
| Facility | | $1,468.94 | $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
- $485.06 / $1,526.00 / $10,546.12
| Professional | | $485.06 | $1,526.00 | $10,546.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $708.69 / $2,289.00 / $15,819.18
| Professional | 50 | $708.69 | $2,289.00 | $15,819.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,951.81 / $11,276.66 / $27,127.53
| Facility | | $7,951.81 | $11,276.66 | $27,127.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.71 / $1,713.54 / $12,942.89
| Professional | | $601.71 | $1,713.54 | $12,942.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,464.25 / $10,309.57 / $21,360.26
| Facility | | $6,464.25 | $10,309.57 | $21,360.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.44 / $2,853.53 / $11,245.00
| Professional | | $527.44 | $2,853.53 | $11,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.19 / $4,500.56 / $9,255.00
| Facility | | $387.19 | $4,500.56 | $9,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,504.25 / $10,278.71 / $19,770.29
| Professional | | $5,504.25 | $10,278.71 | $19,770.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $9,787.00 / $22,901.76
| Facility | | $3,991.00 | $9,787.00 | $22,901.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,385.70 / $10,712.61 / $14,922.20
| Professional | | $4,385.70 | $10,712.61 | $14,922.20 |