- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- 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
- $234.84 / $2,957.47 / $2,957.47
| Professional | | $234.84 | $2,957.47 | $2,957.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.51 / $1,670.37 / $3,135.72
| Facility | | $1,232.51 | $1,670.37 | $3,135.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.90 / $561.13 / $5,817.18
| Professional | | $246.90 | $561.13 | $5,817.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.85 / $5,730.57 / $10,157.02
| Professional | | $564.85 | $5,730.57 | $10,157.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.42 / $2,957.47 / $8,632.00
| Facility | | $299.42 | $2,957.47 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,623.55 / $7,639.15 / $11,142.77
| Professional | | $4,623.55 | $7,639.15 | $11,142.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.76 / $5,730.57 / $10,000.10
| Facility | | $589.76 | $5,730.57 | $10,000.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.04 / $6,428.63 / $9,594.01
| Professional | | $556.04 | $6,428.63 | $9,594.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $9,054.79
| Professional | | $5.00 | $5.00 | $9,054.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $8,632.00 / $10,247.57
| Facility | | $5,341.00 | $8,632.00 | $10,247.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,690.56 / $7,639.15 / $10,278.71
| Professional | | $4,690.56 | $7,639.15 | $10,278.71 |