- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.18 / $1,074.18 / $8,860.00
| Facility | | $1,074.18 | $1,074.18 | $8,860.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.51 / $1,074.18 / $2,094.65
| Professional | | $765.51 | $1,074.18 | $2,094.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.96 / $5,097.16 / $9,450.11
| Facility | | $3,036.96 | $5,097.16 | $9,450.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,328.39 / $8,084.34 / $14,175.17
| Facility | 50 | $5,328.39 | $8,084.34 | $14,175.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.98 / $2,093.67 / $3,462.99
| Professional | | $1,526.98 | $2,093.67 | $3,462.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,473.30 / $3,509.25 / $8,441.98
| Facility | | $2,473.30 | $3,509.25 | $8,441.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.84 / $2,714.39 / $4,278.85
| Professional | | $1,653.84 | $2,714.39 | $4,278.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.65 / $3,208.30 / $6,647.23
| Facility | | $2,011.65 | $3,208.30 | $6,647.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.05 / $2,305.28 / $3,923.95
| Professional | | $1,431.05 | $2,305.28 | $3,923.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.18 / $1,815.36 / $6,043.72
| Facility | | $1,074.18 | $1,815.36 | $6,043.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.10 / $1,674.00 / $3,737.86
| Professional | | $952.10 | $1,674.00 | $3,737.86 |
- 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
- $958.50 / $1,590.30 / $3,637.28
| Professional | | $958.50 | $1,590.30 | $3,637.28 |