- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.00 / $4,500.00 / $8,622.00
| Facility | | $3,422.00 | $4,500.00 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,510.53 / $4,510.53 / $4,510.53
| Facility | 50 | $4,510.53 | $4,510.53 | $4,510.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.84 / $760.25 / $1,397.03
| Professional | | $490.84 | $760.25 | $1,397.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $406.75 / $414.06 / $1,232.98
| Professional | 50 | $406.75 | $414.06 | $1,232.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.66 / $760.77 / $1,110.61
| Professional | | $502.66 | $760.77 | $1,110.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.32 / $973.12 / $1,466.88
| Facility | | $476.32 | $973.12 | $1,466.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.98 / $973.62 / $1,119.79
| Professional | | $627.98 | $973.62 | $1,119.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,130.03
| Professional | | $32.34 | $32.34 | $1,130.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,884.56 / $5,546.60 / $7,080.21
| Facility | | $3,884.56 | $5,546.60 | $7,080.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,407.41 / $8,319.90 / $11,041.11
| Facility | 50 | $5,407.41 | $8,319.90 | $11,041.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.62 / $1,053.40 / $1,297.68
| Professional | | $816.62 | $1,053.40 | $1,297.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $5,550.00 / $12,233.00
| Facility | | $1,150.00 | $5,550.00 | $12,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.60 / $848.25 / $1,259.83
| Professional | | $678.60 | $848.25 | $1,259.83 |