- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.62 / $601.50 / $2,525.00
| Facility | | $245.62 | $601.50 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.62 / $601.50 / $885.18
| Professional | | $245.62 | $601.50 | $885.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,108.82 / $5,677.23 / $12,389.06
| Facility | | $2,108.82 | $5,677.23 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,949.16 / $12,060.61 / $21,147.21
| Facility | 50 | $7,949.16 | $12,060.61 | $21,147.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.93 / $961.18 / $2,052.78
| Professional | | $470.93 | $961.18 | $2,052.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,509.34 / $2,140.42 / $5,149.09
| Facility | | $1,509.34 | $2,140.42 | $5,149.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.67 / $1,232.21 / $2,464.56
| Professional | | $607.67 | $1,232.21 | $2,464.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.98 / $1,956.86 / $4,054.40
| Facility | | $1,226.98 | $1,956.86 | $4,054.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.53 / $1,008.47 / $2,141.25
| Professional | | $540.53 | $1,008.47 | $2,141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.08 / $1,016.54 / $4,746.00
| Facility | | $390.08 | $1,016.54 | $4,746.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.97 / $1,639.01 / $2,524.26
| Professional | | $745.97 | $1,639.01 | $2,524.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.97 / $1,181.33 / $2,309.71
| Professional | | $745.97 | $1,181.33 | $2,309.71 |