- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.88 / $5,721.10 / $12,005.42
| Facility | | $1,008.88 | $5,721.10 | $12,005.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,838.14 / $2,838.14 / $2,838.14
| Facility | 50 | $2,838.14 | $2,838.14 | $2,838.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.54 / $560.13 / $1,118.33
| Professional | | $408.54 | $560.13 | $1,118.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.95 / $418.13 / $703.18
| Professional | | $353.95 | $418.13 | $703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.52 / $4,647.28 / $8,831.95
| Facility | | $1,811.52 | $4,647.28 | $8,831.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.90 / $478.15 / $784.51
| Professional | | $390.90 | $478.15 | $784.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,956.98 / $2,514.75
| Facility | | $580.00 | $1,956.98 | $2,514.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.54 / $591.29 / $1,149.76
| Professional | | $408.54 | $591.29 | $1,149.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.54 / $551.99 / $979.53
| Facility | | $408.54 | $551.99 | $979.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $639.00 / $870.00 / $1,370.87
| Facility | 50 | $639.00 | $870.00 | $1,370.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.86 / $1,731.45 / $1,899.29
| Professional | | $1,145.86 | $1,731.45 | $1,899.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.49 / $382.95 / $696.47
| Professional | | $75.49 | $382.95 | $696.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.22 / $596.39 / $1,324.91
| Professional | | $419.22 | $596.39 | $1,324.91 |