- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.75 / $650.84 / $6,575.00
| Facility | | $508.75 | $650.84 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.48 / $585.97 / $1,055.33
| Professional | | $471.48 | $585.97 | $1,055.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.52 / $4,137.39 / $8,639.27
| Facility | | $2,202.52 | $4,137.39 | $8,639.27 |
- 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
- $799.60 / $1,179.47 / $2,064.79
| Professional | | $799.60 | $1,179.47 | $2,064.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,171.53 / $1,714.16 / $2,866.47
| Professional | 50 | $1,171.53 | $1,714.16 | $2,866.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.08 / $2,144.01 / $5,157.71
| Facility | | $1,511.08 | $2,144.01 | $5,157.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.33 / $1,508.30 / $2,560.94
| Professional | | $870.33 | $1,508.30 | $2,560.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.04 / $1,960.14 / $4,061.19
| Facility | | $1,229.04 | $1,960.14 | $4,061.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.48 / $1,386.80 / $2,407.09
| Professional | | $844.48 | $1,386.80 | $2,407.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.47 / $958.29 / $1,825.97
| Facility | | $604.47 | $958.29 | $1,825.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.33 / $1,115.23 / $2,434.71
| Professional | | $655.33 | $1,115.23 | $2,434.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,361.37 / $1,382.43 / $2,333.08
| Professional | 50 | $1,361.37 | $1,382.43 | $2,333.08 |
- 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
- $673.60 / $1,072.34 / $2,299.69
| Professional | | $673.60 | $1,072.34 | $2,299.69 |