- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $8,317.64
| Facility | | $2,041.74 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 50 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $2,454.71
| Professional | | $724.44 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,884.03 / $4,265.80
| Facility | | $891.25 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,778.28
| Professional | | $891.25 | $891.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $977.24
| Facility | | $741.31 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $1,949.84
| Professional | | $691.83 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,862.09 / $5,370.32
| Facility | | $870.96 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $7,413.10
| Professional | | $707.95 | $933.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,019.95 / $5,370.32
| Facility | | $1,995.26 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,412.54
| Professional | | $676.08 | $831.76 | $1,412.54 |