- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.49 / $2,663.12 / $4,410.00
| Facility | | $584.49 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.33 / $585.99 / $994.59
| Professional | | $456.33 | $585.99 | $994.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,100.80 / $9,039.00
| Facility | | $1,061.00 | $3,100.80 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.59 / $807.61 / $2,204.96
| Professional | | $451.59 | $807.61 | $2,204.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.42 / $698.66 / $1,232.85
| Facility | | $537.42 | $698.66 | $1,232.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.58 / $884.07 / $1,406.70
| Professional | | $424.58 | $884.07 | $1,406.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,039.23 / $1,039.23 / $1,974.44
| Professional | 50 | $1,039.23 | $1,039.23 | $1,974.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.48 / $915.20 / $1,680.06
| Professional | | $476.48 | $915.20 | $1,680.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.06 / $979.94 / $6,679.00
| Facility | | $452.06 | $979.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.94 / $819.21 / $1,130.83
| Professional | | $648.94 | $819.21 | $1,130.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.60 / $1,163.72 / $1,872.36
| Professional | | $554.60 | $1,163.72 | $1,872.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $26,542.00
| Facility | | $1,685.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.70 / $866.06 / $4,405.00
| Professional | | $620.70 | $866.06 | $4,405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.92 / $831.66 / $1,805.07
| Professional | | $588.92 | $831.66 | $1,805.07 |