- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,000.00 / $7,943.28
| Facility | | $380.19 | $1,000.00 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $346.74 / $776.25
| Professional | | $288.40 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $117.49
| Facility | | $114.82 | $114.82 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $831.76
| Professional | | $316.23 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $741.31
| Professional | | $302.00 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $776.25
| Professional | | $478.63 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $602.56
| Facility | | $302.00 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $724.44
| Professional | | $446.68 | $537.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $724.44 / $1,949.84
| Facility | | $181.97 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $630.96
| Professional | | $251.19 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,890.45 / $3,890.45
| Facility | | $56.23 | $3,890.45 | $3,890.45 |
- 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
- $2,454.71 / $2,454.71 / $2,951.21
| Professional | | $2,454.71 | $2,454.71 | $2,951.21 |