- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.22 / $1,631.29 / $2,525.00
| Facility | | $156.22 | $1,631.29 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.43 / $1,555.26 / $2,182.12
| Professional | | $142.43 | $1,555.26 | $2,182.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.92 / $4,067.25 / $8,027.88
| Facility | | $2,359.92 | $4,067.25 | $8,027.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.54 / $1,122.14 / $4,506.68
| Professional | | $269.54 | $1,122.14 | $4,506.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $390.57 / $1,588.65 / $6,745.19
| Professional | 50 | $390.57 | $1,588.65 | $6,745.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,441.49 / $4,880.46 / $11,740.61
| Facility | | $3,441.49 | $4,880.46 | $11,740.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.78 / $2,324.57 / $5,588.06
| Professional | | $335.78 | $2,324.57 | $5,588.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.84 / $4,461.91 / $9,244.58
| Facility | | $2,709.84 | $4,461.91 | $9,244.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.08 / $1,232.00 / $4,526.41
| Professional | | $296.08 | $1,232.00 | $4,526.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.66 / $2,512.66 / $4,884.35
| Facility | | $243.66 | $2,512.66 | $4,884.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,213.38 / $4,074.49 / $7,267.27
| Professional | | $2,213.38 | $4,074.49 | $7,267.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,307.00 / $6,275.00
| Facility | | $1,445.00 | $3,307.00 | $6,275.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.74 / $3,372.27 / $6,939.07
| Professional | | $577.74 | $3,372.27 | $6,939.07 |