- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.02 / $5,467.00 / $12,237.00
| Facility | | $1,013.02 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,535.00 / $1,535.00 / $1,535.00
| Facility | 50 | $1,535.00 | $1,535.00 | $1,535.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.74 / $712.62 / $1,120.29
| Professional | | $578.74 | $712.62 | $1,120.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,510.14 / $1,510.14 / $1,510.14
| Professional | 50 | $1,510.14 | $1,510.14 | $1,510.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.70 / $524.70 / $524.70
| Professional | 50 | $524.70 | $524.70 | $524.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.36 / $3,237.02 / $6,817.19
| Facility | | $2,758.36 | $3,237.02 | $6,817.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.14 / $981.14 / $1,196.23
| Professional | | $981.14 | $981.14 | $1,196.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,517.00 / $12,517.00 / $12,517.00
| Facility | | $12,517.00 | $12,517.00 | $12,517.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.69 / $1,088.44 / $1,627.24
| Professional | | $736.69 | $1,088.44 | $1,627.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.36 / $1,057.41 / $5,562.00
| Facility | | $646.36 | $1,057.41 | $5,562.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.13 / $1,243.49 / $6,141.92
| Professional | | $850.13 | $1,243.49 | $6,141.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.13 / $1,036.24 / $1,653.76
| Professional | | $850.13 | $1,036.24 | $1,653.76 |