- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.25 / $2,678.00 / $4,427.88
| Facility | | $612.25 | $2,678.00 | $4,427.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,244.00 / $2,184.00 / $2,854.00
| Facility | 50 | $1,244.00 | $2,184.00 | $2,854.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.98 / $799.85 / $2,691.90
| Professional | | $290.98 | $799.85 | $2,691.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $642.38 / $1,557.00 / $2,546.46
| Professional | 50 | $642.38 | $1,557.00 | $2,546.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.10 / $356.81 / $356.81
| Professional | | $278.10 | $356.81 | $356.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $256.29 / $256.29 / $733.40
| Professional | 50 | $256.29 | $256.29 | $733.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $6,138.00 / $9,272.00
| Facility | | $3,013.00 | $6,138.00 | $9,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.88 / $1,176.44 / $2,958.06
| Professional | | $385.88 | $1,176.44 | $2,958.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.72 / $558.72 / $1,715.42
| Facility | | $558.72 | $558.72 | $1,715.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.81 / $820.28 / $2,815.60
| Professional | | $344.81 | $820.28 | $2,815.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,084.78 / $3,084.78
| Facility | | $55.00 | $3,084.78 | $3,084.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,263.82 / $11,741.92 / $14,060.18
| Professional | | $6,263.82 | $11,741.92 | $14,060.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,400.00 / $12,467.00
| Facility | | $3,959.00 | $8,400.00 | $12,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.09 / $2,113.41 / $3,450.63
| Professional | | $1,482.09 | $2,113.41 | $3,450.63 |