- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.16 / $533.27 / $4,828.00
| Facility | | $350.16 | $533.27 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.89 / $533.27 / $852.94
| Professional | | $327.89 | $533.27 | $852.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.19 / $4,065.55 / $8,304.51
| Facility | | $1,489.19 | $4,065.55 | $8,304.51 |
- 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
- $566.25 / $889.26 / $1,634.02
| Professional | | $566.25 | $889.26 | $1,634.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.28 / $1,749.85 / $4,209.49
| Facility | | $1,233.28 | $1,749.85 | $4,209.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.96 / $1,130.77 / $2,039.61
| Professional | | $609.96 | $1,130.77 | $2,039.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.09 / $1,599.78 / $3,314.56
| Facility | | $1,003.09 | $1,599.78 | $3,314.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.91 / $1,048.33 / $1,948.66
| Professional | | $636.91 | $1,048.33 | $1,948.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.34 / $652.40 / $1,496.12
| Facility | | $368.34 | $652.40 | $1,496.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.00 / $900.75 / $2,451.84
| Professional | | $495.00 | $900.75 | $2,451.84 |
- 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
- $517.25 / $837.45 / $1,798.06
| Professional | | $517.25 | $837.45 | $1,798.06 |