- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.66 / $4,831.76 / $7,658.88
| Facility | | $2,110.66 | $4,831.76 | $7,658.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.06 / $480.43 / $1,227.83
| Professional | | $368.06 | $480.43 | $1,227.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $206.57 / $619.71 / $1,903.29
| Professional | 50 | $206.57 | $619.71 | $1,903.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,569.00 / $8,284.14 / $10,956.00
| Facility | | $6,569.00 | $8,284.14 | $10,956.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.13 / $714.34 / $984.96
| Professional | | $374.13 | $714.34 | $984.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $561.20 / $1,092.96 / $1,452.06
| Professional | 50 | $561.20 | $1,092.96 | $1,452.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $2,534.25 / $2,534.25
| Facility | | $737.00 | $2,534.25 | $2,534.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.03 / $786.96 / $1,280.60
| Professional | | $535.03 | $786.96 | $1,280.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,910.40 / $5,029.00 / $5,130.00
| Facility | | $3,910.40 | $5,029.00 | $5,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.78 / $752.93 / $1,684.90
| Professional | | $392.78 | $752.93 | $1,684.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,885.93 / $4,885.93 / $8,014.18
| Facility | | $4,885.93 | $4,885.93 | $8,014.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.58 / $712.08 / $1,352.36
| Professional | | $285.58 | $712.08 | $1,352.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.38 / $715.20 / $1,325.24
| Professional | | $390.38 | $715.20 | $1,325.24 |