- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,677.35 / $8,317.64
| Facility | | $2,137.96 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,862.09
| Professional | | $524.81 | $758.58 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,445.44 / $5,370.32
| Professional | 50 | $741.31 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $776.25 / $794.33 / $851.14
| Professional | 50 | $776.25 | $794.33 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,511.89 / $3,801.89
| Facility | | $776.25 | $2,511.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,318.26
| Professional | | $537.03 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $851.14 / $851.14
| Facility | | $776.25 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,479.11
| Professional | | $512.86 | $707.95 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,096.48 / $4,168.69
| Facility | | $562.34 | $1,096.48 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 50 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $7,244.36
| Professional | | $602.56 | $758.58 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | 50 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,019.95 / $5,370.32
| Facility | | $1,995.26 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $1,122.02
| Professional | | $489.78 | $630.96 | $1,122.02 |