- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.00 / $2,869.00 / $7,555.84
| Facility | | $1,227.00 | $2,869.00 | $7,555.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,655.84 / $6,655.84 / $6,655.84
| Facility | 50 | $6,655.84 | $6,655.84 | $6,655.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.79 / $743.90 / $2,248.50
| Professional | | $502.79 | $743.90 | $2,248.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.76 / $4,402.00 / $9,401.00
| Facility | | $1,229.76 | $4,402.00 | $9,401.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.08 / $140.08 / $849.00
| Facility | AS | $140.08 | $140.08 | $849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.00 / $1,008.18 / $5,283.53
| Professional | | $563.00 | $1,008.18 | $5,283.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.08 / $1,070.92 / $1,450.82
| Professional | | $653.08 | $1,070.92 | $1,450.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.26 / $968.27 / $1,558.94
| Professional | | $604.26 | $968.27 | $1,558.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.16 / $1,190.82 / $6,679.00
| Facility | | $549.16 | $1,190.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.16 / $763.33 / $1,047.92
| Professional | | $630.16 | $763.33 | $1,047.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.57 / $1,351.14 / $1,782.37
| Professional | | $681.57 | $1,351.14 | $1,782.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.36 / $4,701.33 / $7,513.12
| Facility | | $3,364.36 | $4,701.33 | $7,513.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.66 / $1,137.34 / $1,722.25
| Professional | | $568.66 | $1,137.34 | $1,722.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $33,500.00
| Facility | | $2,155.00 | $5,268.00 | $33,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.08 / $140.08 / $849.00
| Facility | AS | $140.08 | $140.08 | $849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.74 / $1,027.30 / $5,283.53
| Professional | | $620.74 | $1,027.30 | $5,283.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.36 / $874.15 / $1,766.38
| Professional | | $612.36 | $874.15 | $1,766.38 |