- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,818.38 / $5,623.41
| Facility | | $281.84 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $346.74 / $851.14
| Professional | | $281.84 | $346.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $3,467.37
| Facility | | $56.23 | $758.58 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 54 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $1,148.15
| Professional | | $275.42 | $457.09 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $891.25
| Facility | | $389.05 | $389.05 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $660.69 / $954.99
| Professional | | $389.05 | $660.69 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $912.01
| Professional | | $323.59 | $512.86 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $524.81 / $7,079.46
| Facility | | $177.83 | $524.81 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $691.83
| Professional | | $436.52 | $537.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $977.24
| Professional | | $389.05 | $630.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $3,467.37
| Facility | | $56.23 | $758.58 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 54 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $1,148.15
| Professional | | $275.42 | $457.09 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $1,000.00
| Professional | | $309.03 | $478.63 | $1,000.00 |