- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.04 / $9,185.68 / $20,928.72
| Facility | | $605.04 | $9,185.68 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,997.21 / $5,997.21 / $5,997.21
| Facility | 50 | $5,997.21 | $5,997.21 | $5,997.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.08 / $777.26 / $2,677.20
| Professional | | $467.08 | $777.26 | $2,677.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $552.75 / $552.75 / $552.75
| Professional | 50 | $552.75 | $552.75 | $552.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,104.22 / $6,659.73 / $12,985.98
| Facility | | $5,104.22 | $6,659.73 | $12,985.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.77 / $872.88 / $1,222.90
| Professional | | $494.77 | $872.88 | $1,222.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.00 / $1,539.00 / $1,539.00
| Facility | | $1,539.00 | $1,539.00 | $1,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.58 / $1,442.31 / $1,870.81
| Professional | | $1,115.58 | $1,442.31 | $1,870.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.50 / $1,028.59 / $4,217.00
| Facility | | $560.50 | $1,028.59 | $4,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.81 / $1,309.46 / $1,745.47
| Professional | | $896.81 | $1,309.46 | $1,745.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.32 / $1,487.53 / $1,993.89
| Facility | | $1,095.32 | $1,487.53 | $1,993.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.86 / $1,298.54 / $1,735.43
| Professional | | $980.86 | $1,298.54 | $1,735.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.13 / $3,964.26 / $7,772.00
| Facility | | $2,904.13 | $3,964.26 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.00 / $1,361.03 / $1,705.34
| Professional | | $969.00 | $1,361.03 | $1,705.34 |