- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.42 / $663.77 / $6,575.00
| Facility | | $456.42 | $663.77 | $6,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.42 / $663.77 / $1,067.70
| Professional | | $456.42 | $663.77 | $1,067.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.68 / $4,065.55 / $8,639.27
| Facility | | $1,963.68 | $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
- $730.42 / $1,133.33 / $2,036.11
| Professional | | $730.42 | $1,133.33 | $2,036.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.66 / $2,177.46 / $5,238.16
| Facility | | $1,534.66 | $2,177.46 | $5,238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.26 / $1,414.04 / $2,584.98
| Professional | | $793.26 | $1,414.04 | $2,584.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.21 / $1,990.72 / $4,124.54
| Facility | | $1,248.21 | $1,990.72 | $4,124.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.59 / $1,336.47 / $2,430.08
| Professional | | $816.59 | $1,336.47 | $2,430.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.64 / $861.55 / $1,862.24
| Facility | | $545.64 | $861.55 | $1,862.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,311.70 / $6,311.70 / $6,311.70
| Facility | 50 | $6,311.70 | $6,311.70 | $6,311.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.27 / $1,132.11 / $3,284.00
| Professional | | $650.27 | $1,132.11 | $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
- $619.29 / $1,033.70 / $2,260.44
| Professional | | $619.29 | $1,033.70 | $2,260.44 |