- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,691.53 / $7,079.46
| Facility | | $741.31 | $2,691.53 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $3,548.13 / $18,620.87
| Facility | 50 | $1,778.28 | $3,548.13 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $3,311.31
| Professional | | $302.00 | $758.58 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $741.31 / $2,454.71
| Professional | 50 | $281.84 | $741.31 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $173.78 / $275.42
| Professional | | $147.91 | $173.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $416.87 / $2,344.23
| Professional | 50 | $218.78 | $416.87 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,760.83 / $9,772.37
| Facility | | $3,467.37 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,148.15 / $3,890.45
| Professional | | $426.58 | $1,148.15 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $977.24 / $3,311.31
| Professional | | $380.19 | $977.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $11,481.54 / $11,481.54
| Facility | | $54.95 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,803.84 / $16,595.87 / $16,595.87
| Professional | | $13,803.84 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,302.69
| Facility | | $4,365.16 | $7,585.78 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,621.81 / $3,311.31
| Professional | | $363.08 | $1,621.81 | $3,311.31 |