- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $1,380.38 / $2,951.21
| Professional | | $128.82 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,630.78 / $5,754.40
| Facility | | $2,089.30 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,862.09 / $2,398.83
| Professional | | $213.80 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $331.13 / $346.74 / $3,548.13
| Professional | 50 | $331.13 | $346.74 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $2,754.23
| Professional | | $162.18 | $239.88 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,584.89 / $5,888.44
| Facility | | $154.88 | $1,584.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,380.38 / $2,570.40
| Professional | | $173.78 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,073.80 / $6,025.60
| Facility | | $3,311.31 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $223.87 / $2,511.89
| Professional | | $173.78 | $223.87 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,174.90 / $4,365.16
| Professional | | $213.80 | $1,174.90 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $1,230.27 / $2,754.23
| Professional | | $131.83 | $1,230.27 | $2,754.23 |