- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,691.53 / $3,715.35
| Facility | | $302.00 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $891.25
| Professional | | $275.42 | $354.81 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $28,840.32
| Facility | | $467.74 | $1,023.29 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 54 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $1,174.90
| Professional | | $275.42 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $851.14
| Facility | | $380.19 | $380.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $912.01
| Professional | | $380.19 | $645.65 | $912.01 |
- 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
- $316.23 / $707.95 / $7,079.46
| Facility | | $316.23 | $707.95 | $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
- $380.19 / $602.56 / $977.24
| Professional | | $380.19 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $588.84
| Facility | | $338.84 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $602.56
| Professional | | $323.59 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $28,840.32
| Facility | | $467.74 | $1,023.29 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 54 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $1,174.90
| Professional | | $275.42 | $457.09 | $1,174.90 |
- 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
- $316.23 / $478.63 / $977.24
| Professional | | $316.23 | $478.63 | $977.24 |