- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,949.84 / $7,943.28
| Facility | | $407.38 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,513.56 / $2,884.03
| Professional | | $398.11 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $26,915.35 / $51,286.14
| Facility | | $8,709.64 | $26,915.35 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $26,915.35 / $47,863.01 / $120,226.44
| Facility | 50 | $26,915.35 | $47,863.01 | $120,226.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,041.74 / $4,897.79
| Professional | | $660.69 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,309.57 / $14,791.08
| Facility | | $4,466.84 | $6,309.57 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $2,511.89 / $6,918.31
| Professional | | $870.96 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,025.60 / $11,748.98
| Facility | | $4,786.30 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,511.89 / $6,456.54
| Professional | | $794.33 | $2,511.89 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,548.13 / $12,302.69
| Facility | | $630.96 | $3,548.13 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,981.07 / $8,317.64
| Professional | | $2,344.23 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $28,840.32
| Facility | | $4,897.79 | $10,000.00 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $6,165.95
| Professional | | $575.44 | $1,995.26 | $6,165.95 |