- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.33 / $2,663.12 / $4,685.96
| Facility | | $774.33 | $2,663.12 | $4,685.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.88 / $801.32 / $1,290.90
| Professional | | $656.88 | $801.32 | $1,290.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,950.84 / $9,039.00
| Facility | | $1,313.00 | $3,950.84 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.33 / $1,024.68 / $2,913.03
| Professional | | $592.33 | $1,024.68 | $2,913.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.57 / $996.31 / $1,760.81
| Facility | | $767.57 | $996.31 | $1,760.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.16 / $1,373.18 / $1,843.70
| Professional | | $922.16 | $1,373.18 | $1,843.70 |
- 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
- $654.95 / $1,279.58 / $2,414.83
| Professional | | $654.95 | $1,279.58 | $2,414.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.46 / $1,399.58 / $6,679.00
| Facility | | $647.46 | $1,399.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.49 / $1,071.93 / $1,479.68
| Professional | | $853.49 | $1,071.93 | $1,479.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.44 / $1,655.78 / $2,510.59
| Professional | | $795.44 | $1,655.78 | $2,510.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.56 / $1,016.56 / $1,016.56
| Professional | | $1,016.56 | $1,016.56 | $1,016.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,449.12 / $26,542.00
| Facility | | $1,685.00 | $4,449.12 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.76 / $1,102.52 / $5,606.00
| Professional | | $755.76 | $1,102.52 | $5,606.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,997.00 / $9,039.00
| Facility | | $1,685.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.86 / $1,012.11 / $2,308.04
| Professional | | $748.86 | $1,012.11 | $2,308.04 |