- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.42 / $8,477.27 / $21,899.37
| Facility | | $478.42 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.40 / $800.87 / $1,212.46
| Professional | | $461.40 | $800.87 | $1,212.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $692.10 / $692.10 / $692.10
| Professional | 50 | $692.10 | $692.10 | $692.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.52 / $922.52 / $1,121.30
| Professional | | $922.52 | $922.52 | $1,121.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.02 / $5,453.87 / $10,634.64
| Facility | | $4,180.02 | $5,453.87 | $10,634.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.49 / $775.80 / $1,051.10
| Professional | | $462.49 | $775.80 | $1,051.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.05 / $408.05 / $408.05
| Facility | | $408.05 | $408.05 | $408.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.94 / $1,170.44 / $1,515.93
| Professional | | $1,003.94 | $1,170.44 | $1,515.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.42 / $876.66 / $4,074.84
| Facility | | $478.42 | $876.66 | $4,074.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.81 / $1,089.00 / $1,425.67
| Professional | | $735.81 | $1,089.00 | $1,425.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.16 / $1,076.40 / $1,369.36
| Facility | | $458.16 | $1,076.40 | $1,369.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.77 / $1,159.01 / $1,502.74
| Professional | | $963.77 | $1,159.01 | $1,502.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.98 / $1,094.16 / $1,373.51
| Professional | | $826.98 | $1,094.16 | $1,373.51 |