- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $5,180.79
| Facility | | $1,758.00 | $2,747.00 | $5,180.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.54 / $1,106.19 / $1,722.65
| Professional | | $827.54 | $1,106.19 | $1,722.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.56 / $1,395.63 / $7,410.64
| Professional | | $904.56 | $1,395.63 | $7,410.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.43 / $2,048.82 / $2,722.49
| Professional | | $1,355.43 | $2,048.82 | $2,722.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,039.23 / $1,039.23 / $3,240.78
| Professional | 50 | $1,039.23 | $1,039.23 | $3,240.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.52 / $1,838.65 / $3,062.57
| Professional | | $933.52 | $1,838.65 | $3,062.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.29 / $1,909.00 / $6,679.00
| Facility | | $1,024.29 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.83 / $1,424.57 / $1,966.47
| Professional | | $1,131.83 | $1,424.57 | $1,966.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.51 / $2,518.53 / $5,944.58
| Professional | | $1,250.51 | $2,518.53 | $5,944.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.88 / $2,493.61 / $8,609.65
| Professional | | $2,431.88 | $2,493.61 | $8,609.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,580.18 / $26,542.00
| Facility | | $2,155.00 | $5,580.18 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.61 / $1,401.16 / $7,410.64
| Professional | | $982.61 | $1,401.16 | $7,410.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.00 / $5,268.00 / $10,910.95
| Facility | | $2,175.00 | $5,268.00 | $10,910.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.28 / $1,340.55 / $3,443.58
| Professional | | $961.28 | $1,340.55 | $3,443.58 |