- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.00 / $8,146.00 / $22,387.30
| Facility | | $1,022.00 | $8,146.00 | $22,387.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $22,387.30 / $22,387.30 / $22,387.30
| Facility | 50 | $22,387.30 | $22,387.30 | $22,387.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.24 / $3,212.13 / $5,214.01
| Professional | | $274.24 | $3,212.13 | $5,214.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.77 / $2,771.94 / $2,771.94
| Professional | | $141.77 | $2,771.94 | $2,771.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $4,157.91 / $4,157.91 / $4,157.91
| Professional | 50 | $4,157.91 | $4,157.91 | $4,157.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $7,079.26 / $8,427.70
| Facility | | $323.00 | $7,079.26 | $8,427.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.01 / $1,062.09 / $5,843.12
| Professional | | $301.01 | $1,062.09 | $5,843.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,538.00 / $23,016.00 / $45,285.00
| Facility | | $9,538.00 | $23,016.00 | $45,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,086.41 / $2,235.44 / $4,508.20
| Professional | | $2,086.41 | $2,235.44 | $4,508.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,302.73 / $3,434.75 / $4,568.37
| Professional | | $2,302.73 | $3,434.75 | $4,568.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,368.00 / $16,613.00 / $30,169.00
| Facility | | $7,368.00 | $16,613.00 | $30,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,801.93 / $4,296.29 / $7,375.17
| Professional | | $2,801.93 | $4,296.29 | $7,375.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.28 / $2,266.88 / $2,266.88
| Professional | | $229.28 | $2,266.88 | $2,266.88 |