- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.66 / $1,756.94 / $2,525.00
| Facility | | $323.66 | $1,756.94 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.02 / $1,404.70 / $2,106.21
| Professional | | $284.02 | $1,404.70 | $2,106.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.00 / $7,195.80 / $11,327.71
| Facility | | $3,630.00 | $7,195.80 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,268.16 / $11,027.38 / $19,335.54
| Facility | 50 | $7,268.16 | $11,027.38 | $19,335.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.66 / $1,997.50 / $5,364.09
| Professional | | $663.66 | $1,997.50 | $5,364.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $987.62 / $2,860.82 / $8,046.14
| Professional | 50 | $987.62 | $2,860.82 | $8,046.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,596.14 / $5,612.65 / $13,501.99
| Facility | | $3,596.14 | $5,612.65 | $13,501.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.65 / $1,511.79 / $5,974.39
| Professional | | $465.65 | $1,511.79 | $5,974.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,116.38 / $4,948.52 / $10,631.49
| Facility | | $3,116.38 | $4,948.52 | $10,631.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.02 / $2,026.53 / $5,388.05
| Professional | | $630.02 | $2,026.53 | $5,388.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.16 / $1,644.32 / $3,999.68
| Facility | | $406.16 | $1,644.32 | $3,999.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.92 / $3,157.84 / $6,848.49
| Professional | | $1,578.92 | $3,157.84 | $6,848.49 |
- 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
- $1,577.99 / $2,605.21 / $5,693.55
| Professional | | $1,577.99 | $2,605.21 | $5,693.55 |