- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.12 / $752.52 / $6,219.27
| Facility | | $491.12 | $752.52 | $6,219.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.26 / $701.39 / $1,214.96
| Professional | | $463.26 | $701.39 | $1,214.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.57 / $5,601.46 / $11,441.84
| Facility | | $2,226.57 | $5,601.46 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,341.39 / $11,138.50 / $19,530.37
| Facility | 50 | $7,341.39 | $11,138.50 | $19,530.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.09 / $1,577.71 / $2,626.57
| Professional | | $905.09 | $1,577.71 | $2,626.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.46 / $2,646.87 / $6,367.40
| Facility | | $1,866.46 | $2,646.87 | $6,367.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.29 / $2,032.64 / $3,215.34
| Professional | | $1,193.29 | $2,032.64 | $3,215.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.30 / $2,419.87 / $5,013.70
| Facility | | $1,517.30 | $2,419.87 | $5,013.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.42 / $1,683.54 / $2,975.06
| Professional | | $1,061.42 | $1,683.54 | $2,975.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.20 / $1,149.66 / $4,746.00
| Facility | | $687.20 | $1,149.66 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $49.90 / $49.90 / $49.90
| Facility | 50 | $49.90 | $49.90 | $49.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.63 / $1,967.48 / $5,058.00
| Professional | | $971.63 | $1,967.48 | $5,058.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,289.00 / $8,193.00
| Facility | | $2,740.00 | $4,289.00 | $8,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.23 / $1,761.49 / $2,854.76
| Professional | | $902.23 | $1,761.49 | $2,854.76 |