- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,758.00 / $7,467.00
| Facility | | $1,671.00 | $3,758.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,564.50 / $4,564.50 / $4,564.50
| Facility | 50 | $4,564.50 | $4,564.50 | $4,564.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.88 / $1,250.00 / $3,590.60
| Professional | | $318.88 | $1,250.00 | $3,590.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.42 / $964.84 / $1,254.29
| Professional | | $231.42 | $964.84 | $1,254.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,447.26 / $1,447.26 / $1,447.26
| Professional | 50 | $1,447.26 | $1,447.26 | $1,447.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,787.48 / $4,140.09
| Facility | | $688.17 | $2,787.48 | $4,140.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.45 / $311.33 / $1,399.71
| Professional | | $259.45 | $311.33 | $1,399.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,926.78 / $2,926.78 / $2,926.78
| Facility | | $2,926.78 | $2,926.78 | $2,926.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.70 / $1,028.94 / $2,415.07
| Professional | | $304.70 | $1,028.94 | $2,415.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.27 / $1,343.06 / $5,740.00
| Facility | | $298.27 | $1,343.06 | $5,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.72 / $1,944.60 / $12,119.05
| Professional | | $1,334.72 | $1,944.60 | $12,119.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,336.00 / $4,635.00 / $7,217.00
| Facility | | $3,336.00 | $4,635.00 | $7,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.62 / $1,751.86 / $2,537.63
| Professional | | $1,323.62 | $1,751.86 | $2,537.63 |