- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,344.23 / $12,022.64
| Facility | | $812.83 | $2,344.23 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | 50 | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $794.33 / $1,258.93
| Professional | | $407.38 | $794.33 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $891.25
| Professional | | $354.81 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $17,378.01
| Facility | | $6,918.31 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $1,000.00
| Professional | | $407.38 | $707.95 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $1,513.56
| Professional | | $457.09 | $954.99 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $6,309.57
| Facility | | $426.58 | $851.14 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $954.99 / $3,890.45
| Professional | | $630.96 | $954.99 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,174.90 / $1,479.11
| Professional | | $954.99 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,148.15
| Professional | | $912.01 | $912.01 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $501.19 / $1,380.38
| Professional | | $6.03 | $501.19 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $8,128.31
| Facility | | $3,630.78 | $5,495.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $851.14 / $1,230.27
| Professional | | $562.34 | $851.14 | $1,230.27 |