- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,630.78 / $6,456.54
| Facility | | $2,570.40 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | 50 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $2,951.21
| Professional | | $812.83 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $11,220.18
| Facility | | $1,698.24 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $7,079.46
| Professional | | $870.96 | $1,318.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,995.26 / $2,691.53
| Professional | | $1,174.90 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,698.24 / $2,818.38
| Professional | | $851.14 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,949.84 / $7,079.46
| Facility | | $812.83 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,737.80
| Professional | | $1,000.00 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,584.89 / $2,884.03
| Professional | | $891.25 | $1,584.89 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,495.41
| Facility | | $5,248.07 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $2,691.53
| Professional | | $1,548.82 | $1,548.82 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,981.07 / $11,220.18
| Facility | | $1,995.26 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $7,079.46
| Professional | | $794.33 | $1,318.26 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,120.11
| Facility | | $1,698.24 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,818.38
| Professional | | $891.25 | $1,288.25 | $2,818.38 |