- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.98 / $8,477.27 / $19,276.96
| Facility | | $3,719.98 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,764.85 / $4,764.85 / $4,764.85
| Facility | 50 | $4,764.85 | $4,764.85 | $4,764.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.99 / $1,556.10 / $1,571.28
| Professional | | $144.99 | $1,556.10 | $1,571.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $6,553.20 / $6,553.20 / $6,553.20
| Professional | 50 | $6,553.20 | $6,553.20 | $6,553.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,503.12 / $7,458.15 / $14,000.85
| Facility | | $5,503.12 | $7,458.15 | $14,000.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.55 / $346.70 / $3,093.84
| Professional | | $152.55 | $346.70 | $3,093.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.37 / $3,047.79 / $5,390.93
| Professional | | $351.37 | $3,047.79 | $5,390.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.86 / $2,636.26 / $7,441.00
| Facility | | $184.86 | $2,636.26 | $7,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,424.42 / $4,058.62 / $6,092.23
| Professional | | $2,424.42 | $4,058.62 | $6,092.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.77 / $3,787.55 / $5,710.87
| Facility | | $363.77 | $3,787.55 | $5,710.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.97 / $3,284.73 / $5,042.60
| Professional | | $344.97 | $3,284.73 | $5,042.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $373.30 / $5,102.00
| Professional | | $5.00 | $373.30 | $5,102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,635.25 / $4,058.62 / $4,919.12
| Professional | | $2,635.25 | $4,058.62 | $4,919.12 |