- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $5,011.87 / $12,589.25
| Facility | | $758.58 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $446.68 / $1,412.54
| Professional | | $263.03 | $446.68 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $660.69
| Professional | | $275.42 | $478.63 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $1,023.29
| Professional | | $346.74 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $1,230.27
| Facility | | $309.03 | $501.19 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 54 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $2,511.89
| Professional | | $363.08 | $645.65 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $741.31 / $933.25
| Professional | | $660.69 | $741.31 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,047.13
| Professional | | $676.08 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $4,466.84
| Facility | | $309.03 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $794.33
| Professional | | $338.84 | $537.03 | $794.33 |