- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.53 / $3,795.64 / $13,841.56
| Facility | | $775.53 | $3,795.64 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,420.24 / $3,420.24 / $3,420.24
| Facility | 50 | $3,420.24 | $3,420.24 | $3,420.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.75 / $438.12 / $978.84
| Professional | | $100.75 | $438.12 | $978.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $876.25 / $1,144.56 / $1,287.27
| Professional | 50 | $876.25 | $1,144.56 | $1,287.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.41 / $1,739.33 / $3,364.42
| Facility | | $1,322.41 | $1,739.33 | $3,364.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.72 / $369.85 / $1,538.11
| Professional | | $162.72 | $369.85 | $1,538.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.07 / $1,515.23 / $2,465.23
| Professional | | $370.07 | $1,515.23 | $2,465.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.42 / $1,163.30 / $1,835.41
| Facility | | $231.42 | $1,163.30 | $1,835.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.72 / $1,770.34 / $6,036.72
| Professional | | $1,067.72 | $1,770.34 | $6,036.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.09 / $1,515.23 / $2,321.40
| Facility | | $374.09 | $1,515.23 | $2,321.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.09 / $1,515.23 / $2,321.40
| Professional | | $374.09 | $1,515.23 | $2,321.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.98 / $1,914.50 / $2,497.85
| Professional | | $1,231.98 | $1,914.50 | $2,497.85 |