- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.83 / $2,180.34 / $7,761.00
| Facility | | $882.83 | $2,180.34 | $7,761.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.56 / $741.88 / $1,832.22
| Professional | | $359.56 | $741.88 | $1,832.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $516.03 / $1,419.14 / $1,502.03
| Professional | 50 | $516.03 | $1,419.14 | $1,502.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,263.88 / $6,263.88 / $6,281.49
| Facility | | $6,263.88 | $6,263.88 | $6,281.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.97 / $663.97 / $1,331.26
| Professional | | $382.97 | $663.97 | $1,331.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.04 / $853.16 / $2,216.98
| Facility | | $300.04 | $853.16 | $2,216.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.15 / $1,142.69 / $1,728.87
| Professional | | $485.15 | $1,142.69 | $1,728.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $983.63 / $1,237.47
| Professional | | $32.34 | $983.63 | $1,237.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,328.80 / $17,085.84 / $22,023.84
| Facility | | $12,328.80 | $17,085.84 | $22,023.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $17,927.58 / $25,628.78 / $33,035.76
| Facility | 50 | $17,927.58 | $25,628.78 | $33,035.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.19 / $1,042.73 / $1,587.23
| Professional | | $557.19 | $1,042.73 | $1,587.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $11,800.00 / $163,191.00
| Facility | | $2,600.00 | $11,800.00 | $163,191.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.67 / $1,186.58 / $1,720.02
| Professional | | $811.67 | $1,186.58 | $1,720.02 |