- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,822.00 / $6,075.00
| Facility | | $1,525.00 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $770.56 / $3,589.74 / $7,610.40
| Facility | 50 | $770.56 | $3,589.74 | $7,610.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.60 / $423.18 / $851.22
| Professional | | $304.60 | $423.18 | $851.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $502.59 / $2,795.80 / $4,784.64
| Professional | 50 | $502.59 | $2,795.80 | $4,784.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.19 / $5,268.00 / $15,940.91
| Facility | | $779.19 | $5,268.00 | $15,940.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.67 / $648.79 / $6,125.60
| Professional | | $345.67 | $648.79 | $6,125.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.45 / $606.45 / $606.45
| Professional | | $606.45 | $606.45 | $606.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.92 / $671.17 / $1,192.83
| Professional | | $453.92 | $671.17 | $1,192.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.32 / $674.32 / $6,679.00
| Facility | | $316.32 | $674.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.98 / $455.17 / $820.06
| Professional | | $362.98 | $455.17 | $820.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.67 / $789.12 / $1,051.69
| Professional | | $395.67 | $789.12 | $1,051.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.63 / $5,438.31 / $14,557.12
| Facility | | $1,372.63 | $5,438.31 | $14,557.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $573.20 / $573.20
| Professional | | $573.20 | $573.20 | $573.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.78 / $6,104.00 / $26,542.00
| Facility | | $1,779.78 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.34 / $708.91 / $6,125.60
| Professional | | $431.34 | $708.91 | $6,125.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $20,029.34
| Facility | | $2,155.00 | $6,104.00 | $20,029.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.67 / $629.69 / $1,179.74
| Professional | | $422.67 | $629.69 | $1,179.74 |