- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,398.83
| Facility | | $1,023.29 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,412.54
| Professional | | $575.44 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | 50 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $794.33 / $794.33 / $851.14
| Professional | 50 | $794.33 | $794.33 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $3,630.78
| Facility | | $2,238.72 | $2,691.53 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $1,513.56
| Professional | | $831.76 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 22 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $2,344.23
| Professional | | $436.52 | $645.65 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,951.21 / $4,073.80
| Facility | | $831.76 | $2,951.21 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $870.96
| Professional | | $489.78 | $645.65 | $870.96 |