- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,894.00 / $6,075.00
| Facility | | $1,525.00 | $2,894.00 | $6,075.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,992.14 / $5,992.14 / $5,992.14
| Facility | 50 | $5,992.14 | $5,992.14 | $5,992.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.14 / $1,019.11 / $2,085.14
| Professional | | $802.14 | $1,019.11 | $2,085.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,950.84 / $9,039.00
| Facility | | $1,313.00 | $3,950.84 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.82 / $1,313.82 / $7,043.92
| Professional | | $863.82 | $1,313.82 | $7,043.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.25 / $1,952.86 / $2,594.82
| Professional | | $1,475.25 | $1,952.86 | $2,594.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.29 / $1,689.46 / $2,821.22
| Professional | | $854.29 | $1,689.46 | $2,821.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.13 / $1,909.00 / $6,679.00
| Facility | | $975.13 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.52 / $1,357.76 / $1,874.24
| Professional | | $1,077.52 | $1,357.76 | $1,874.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.89 / $2,396.44 / $3,784.87
| Professional | | $1,189.89 | $2,396.44 | $3,784.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,301.97 / $5,301.97 / $5,532.39
| Facility | | $5,301.97 | $5,301.97 | $5,532.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.85 / $1,555.45 / $2,703.14
| Professional | | $1,546.85 | $1,555.45 | $2,703.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $26,542.00
| Facility | | $1,685.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.98 / $1,409.02 / $7,043.92
| Professional | | $920.98 | $1,409.02 | $7,043.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.33 / $1,279.82 / $2,844.31
| Professional | | $901.33 | $1,279.82 | $2,844.31 |