- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $8,447.00
| Facility | | $1,965.00 | $4,474.00 | $8,447.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,668.00 / $7,668.00 / $7,668.00
| Facility | 50 | $7,668.00 | $7,668.00 | $7,668.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.02 / $622.69 / $2,677.20
| Professional | | $480.02 | $622.69 | $2,677.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $406.75 / $1,232.98 / $4,635.81
| Professional | 50 | $406.75 | $1,232.98 | $4,635.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $322.49 / $322.49 / $827.64
| Professional | 50 | $322.49 | $322.49 | $827.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.28 / $491.95 / $588.37
| Professional | | $441.28 | $491.95 | $588.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.00 / $775.00 / $858.00
| Facility | | $775.00 | $775.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.00 / $606.90 / $1,214.33
| Professional | | $442.00 | $606.90 | $1,214.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.59 / $811.86 / $3,978.00
| Facility | | $489.59 | $811.86 | $3,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.74 / $659.00 / $4,849.92
| Professional | | $521.74 | $659.00 | $4,849.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.00 / $3,339.00 / $5,838.00
| Facility | | $2,286.00 | $3,339.00 | $5,838.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.15 / $627.41 / $1,236.05
| Professional | | $507.15 | $627.41 | $1,236.05 |