- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,187.76 / $3,801.89
| Facility | | $691.83 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $1,737.80
| Professional | | $575.44 | $758.58 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $2,290.87 / $2,398.83
| Professional | 50 | $1,148.15 | $2,290.87 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,398.83 / $19,498.45
| Facility | | $1,258.93 | $2,398.83 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 54 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $2,187.76
| Professional | | $524.81 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,621.81
| Facility | | $707.95 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,230.27 / $1,737.80
| Professional | | $707.95 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $676.08 / $891.25 / $891.25
| Professional | 50 | $676.08 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,174.90 / $2,187.76
| Professional | | $602.56 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,174.90 / $7,079.46
| Facility | | $380.19 | $1,174.90 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,380.38
| Professional | | $794.33 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,862.09
| Professional | | $630.96 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,258.93 / $2,041.74
| Professional | | $1,096.48 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,818.38 / $19,498.45
| Facility | | $1,348.96 | $2,818.38 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 54 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $2,187.76
| Professional | | $524.81 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,311.31 / $8,511.38
| Facility | | $1,258.93 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $1,862.09
| Professional | | $616.60 | $870.96 | $1,862.09 |