- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.41 / $8,477.27 / $21,899.37
| Facility | | $580.41 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,462.81 / $9,297.87 / $9,297.87
| Facility | 50 | $6,462.81 | $9,297.87 | $9,297.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.58 / $580.41 / $2,904.68
| Professional | | $513.58 | $580.41 | $2,904.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $513.58 / $772.40 / $2,065.29
| Professional | 50 | $513.58 | $772.40 | $2,065.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,099.31 / $6,706.99 / $12,973.48
| Facility | | $5,099.31 | $6,706.99 | $12,973.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.03 / $899.46 / $1,206.91
| Professional | | $531.03 | $899.46 | $1,206.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.16 / $1,352.97 / $1,778.72
| Professional | | $637.16 | $1,352.97 | $1,778.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.41 / $1,102.78 / $3,726.00
| Facility | | $580.41 | $1,102.78 | $3,726.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,844.93 / $1,844.93 / $1,844.93
| Facility | 50 | $1,844.93 | $1,844.93 | $1,844.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.68 / $1,290.91 / $4,664.16
| Professional | | $732.68 | $1,290.91 | $4,664.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.41 / $1,436.07 / $1,905.27
| Facility | | $1,170.41 | $1,436.07 | $1,905.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.00 / $1,267.11 / $1,681.05
| Professional | | $975.00 | $1,267.11 | $1,681.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.68 / $1,290.91 / $1,499.20
| Professional | | $732.68 | $1,290.91 | $1,499.20 |