- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,897.79 / $10,715.19
| Facility | | $1,047.13 | $4,897.79 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $954.99 / $1,445.44 / $17,782.79
| Facility | 50 | $954.99 | $1,445.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $912.01 / $4,677.35
| Professional | | $229.09 | $912.01 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.87 / $5,888.44 / $11,481.54
| Professional | 50 | $416.87 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $3,019.95
| Professional | | $2,630.27 | $2,630.27 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $4,073.80 / $6,165.95
| Professional | 50 | $3,715.35 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,090.30 / $3,715.35
| Facility | | $34.67 | $3,090.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $2,290.87 / $6,165.95
| Professional | | $263.03 | $2,290.87 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,137.96 / $3,801.89
| Professional | | $1,995.26 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,762.47 / $12,022.64
| Facility | | $2,630.27 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $2,398.83 / $5,888.44
| Professional | | $239.88 | $2,398.83 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $2,454.71 / $2,884.03
| Professional | | $208.93 | $2,454.71 | $2,884.03 |