- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.17 / $2,663.12 / $3,693.00
| Facility | | $870.17 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,118.84 / $3,118.84 / $3,118.84
| Facility | 50 | $3,118.84 | $3,118.84 | $3,118.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.94 / $533.40 / $1,891.15
| Professional | | $117.94 | $533.40 | $1,891.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $800.10 / $800.10 / $5,531.40
| Professional | 50 | $800.10 | $800.10 | $5,531.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.61 / $2,948.45 / $4,755.00
| Facility | | $367.61 | $2,948.45 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.11 / $1,520.49 / $4,218.18
| Professional | | $165.11 | $1,520.49 | $4,218.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.45 / $225.49 / $442.30
| Facility | | $173.45 | $225.49 | $442.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.44 / $284.44 / $1,843.10
| Professional | | $284.44 | $284.44 | $1,843.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.57 / $840.70 / $3,055.01
| Professional | | $236.57 | $840.70 | $3,055.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.50 / $237.21 / $6,679.00
| Facility | | $150.50 | $237.21 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.67 / $1,332.06 / $2,373.73
| Professional | | $1,050.67 | $1,332.06 | $2,373.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.51 / $1,100.59 / $2,443.44
| Professional | | $188.51 | $1,100.59 | $2,443.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.17 / $2,353.62 / $6,419.20
| Professional | | $1,382.17 | $2,353.62 | $6,419.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.59 / $1,683.71 / $3,078.46
| Professional | | $1,233.59 | $1,683.71 | $3,078.46 |