- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.14 / $3,847.00 / $7,625.00
| Facility | | $1,075.14 | $3,847.00 | $7,625.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,933.50 / $6,052.50 / $7,571.23
| Facility | 50 | $4,933.50 | $6,052.50 | $7,571.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.54 / $894.36 / $2,335.73
| Professional | | $586.54 | $894.36 | $2,335.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.63 / $5,904.00 / $12,131.00
| Facility | | $1,329.63 | $5,904.00 | $12,131.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.97 / $1,403.30 / $7,060.12
| Professional | | $570.97 | $1,403.30 | $7,060.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.28 / $866.16 / $1,528.45
| Facility | | $666.28 | $866.16 | $1,528.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.93 / $1,407.93 / $2,817.15
| Professional | | $778.93 | $1,407.93 | $2,817.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.08 / $1,214.90 / $8,208.00
| Facility | | $568.08 | $1,214.90 | $8,208.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.64 / $881.30 / $1,362.69
| Professional | | $457.64 | $881.30 | $1,362.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.22 / $1,538.04 / $2,233.51
| Professional | | $724.22 | $1,538.04 | $2,233.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,320.31 / $6,058.56 / $9,478.74
| Facility | | $4,320.31 | $6,058.56 | $9,478.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.77 / $1,293.51 / $1,759.99
| Professional | | $865.77 | $1,293.51 | $1,759.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $14,018.00
| Facility | | $2,386.00 | $6,883.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.71 / $1,895.98 / $7,060.12
| Professional | | $940.71 | $1,895.98 | $7,060.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.22 / $1,315.99 / $3,354.75
| Professional | | $857.22 | $1,315.99 | $3,354.75 |