- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.75 / $9,544.15 / $20,928.72
| Facility | | $689.75 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,540.31 / $8,540.31 / $8,540.31
| Facility | 50 | $8,540.31 | $8,540.31 | $8,540.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.53 / $689.75 / $1,455.37
| Professional | | $550.53 | $689.75 | $1,455.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $733.32 / $2,043.56 / $4,506.14
| Professional | 50 | $733.32 | $2,043.56 | $4,506.14 |
- 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
- $583.64 / $1,019.36 / $1,391.58
| Professional | | $583.64 | $1,019.36 | $1,391.58 |
- 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
- $1,314.63 / $1,657.93 / $2,123.05
| Professional | | $1,314.63 | $1,657.93 | $2,123.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.64 / $1,126.45 / $4,217.00
| Facility | | $660.64 | $1,126.45 | $4,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.37 / $1,500.92 / $2,006.70
| Professional | | $1,016.37 | $1,500.92 | $2,006.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.30 / $1,596.06 / $2,054.87
| Facility | | $1,143.30 | $1,596.06 | $2,054.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.00 / $1,492.87 / $1,975.63
| Professional | | $1,127.00 | $1,492.87 | $1,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.68 / $1,546.27 / $1,954.68
| Professional | | $1,110.68 | $1,546.27 | $1,954.68 |