- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,079.46 / $20,892.96
| Facility | | $1,949.84 | $7,079.46 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $30,199.52 / $30,199.52 / $30,199.52
| Facility | 50 | $30,199.52 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,659.59 / $4,365.16
| Professional | | $363.08 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | 50 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,548.82 / $6,025.60
| Professional | | $338.84 | $1,548.82 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,905.46 / $4,897.79
| Facility | | $398.11 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $30,199.52 / $30,199.52 / $30,199.52
| Facility | 50 | $30,199.52 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,187.76 / $7,244.36
| Professional | | $794.33 | $2,187.76 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $234.42 / $338.84
| Professional | 50 | $234.42 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,344.23 / $8,709.64
| Professional | | $1,230.27 | $2,344.23 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,737.80 / $3,311.31
| Facility | | $363.08 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,445.44 / $4,365.16
| Professional | | $309.03 | $1,445.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,905.46 / $4,786.30
| Professional | | $851.14 | $1,905.46 | $4,786.30 |