- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.05 / $663.40 / $6,575.00
| Facility | | $456.05 | $663.40 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.05 / $663.40 / $1,317.93
| Professional | | $456.05 | $663.40 | $1,317.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,962.07 / $4,065.55 / $8,639.27
| Facility | | $1,962.07 | $4,065.55 | $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
- $728.70 / $1,130.83 / $2,034.99
| Professional | | $728.70 | $1,130.83 | $2,034.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.81 / $2,176.26 / $5,235.29
| Facility | | $1,533.81 | $2,176.26 | $5,235.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.02 / $1,412.47 / $2,582.53
| Professional | | $815.02 | $1,412.47 | $2,582.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.52 / $1,989.62 / $4,122.28
| Facility | | $1,247.52 | $1,989.62 | $4,122.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.87 / $1,335.42 / $2,427.38
| Professional | | $828.87 | $1,335.42 | $2,427.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.96 / $861.04 / $1,861.21
| Facility | | $525.96 | $861.04 | $1,861.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.49 / $1,132.82 / $3,284.00
| Professional | | $626.49 | $1,132.82 | $3,284.00 |
- 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
- $650.27 / $1,059.04 / $2,321.35
| Professional | | $650.27 | $1,059.04 | $2,321.35 |