- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,884.03 / $6,760.83
| Facility | | $1,380.38 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 50 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $1,000.00
| Professional | | $169.82 | $309.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.87 / $851.14 / $1,659.59
| Professional | 50 | $416.87 | $851.14 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $245.47 / $331.13
| Professional | | $147.91 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $389.05 / $524.81
| Professional | 50 | $302.00 | $389.05 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $389.05
| Professional | | $117.49 | $194.98 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $478.63
| Professional | | $169.82 | $281.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $3,090.30
| Facility | | $177.83 | $323.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | 50 | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $3,388.44
| Professional | | $245.47 | $346.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,041.74 / $4,786.30
| Facility | | $1,288.25 | $2,041.74 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $416.87
| Professional | | $158.49 | $257.04 | $416.87 |